Acellular tissue matrix compositions for tissue repair

ABSTRACT

The invention provides tissue repair compositions and methods of making the tissue repair compositions. Also featured are methods of treatment using the tissue repair compositions and articles of manufacture that include the tissue repair compositions.

RELATED APPLICATIONS

This application is a divisional application of U.S. patent applicationSer. No. 15/176,863, filed Jun. 8, 2016, which is a continuationapplication of U.S. patent application Ser. No. 12/747,441, filed Jun.10, 2010, now U.S. Pat. No. 9,382,422, which is a national phaseapplication under 35 U.S.C. § 371 of International Application No.PCT/US2008/069563, filed Jul. 9, 2008, which claims the benefit ofpriority under 35 U.S.C. § 119 to U.S. Provisional Application No.60/948,793, filed Jul. 10, 2007. All applications are incorporatedherein by reference.

TECHNICAL FIELD

This invention relates to tissue engineering, and more particularly tomaterial that can be implanted in, or grafted to, vertebrate subjectsfor repair or amelioration of defective or damaged tissues.

BACKGROUND

Multicellular organisms, including mammals, are made up of tissues, thatis, organized aggregates of specialized groups of cells of similar formand function. In many tissue types, the cells are also surrounded by anextracellular matrix (ECM), a complex mixture of carbohydrates andproteins that provides support and anchorage for cells. When tissuesbecome damaged, an ordered series of physiological events must takeplace in a timely fashion for successful tissue regeneration to occur.The first events, termed the inflammatory phase, include blood clottingas well as the arrival at the wound site of cells that remove bacteria,debris and damaged tissue. Later, circulating stem cells migrate to thewound site and differentiate into tissue-specific cell types. Finally,the differentiated cells begin to produce and deposit new ECM.

Successful repair of defective or damaged tissue depends in part onproviding conditions that allow for appropriate cellular regenerationand that minimize the likelihood of infection during the repair process.

SUMMARY

The inventors have found that fragments of an acellular tissue matrices(ATM), swollen in an acidic solution, can be dried to make abiocompatible tissue repair composition. In preferred embodiments, thesuspension of ATM in acid solution is heated at mildly elevatedtemperatures prior to drying. Such biocompatible tissue repaircompositions can provide a means of repairing multiple defective ordamaged tissues while minimizing the promotion of adhesions orinfection.

More specifically, a method of making a biocompatible mesh compositionis provided. The method includes: a) incubating a plurality of fragmentsof an acellular tissue matrix (ATM) in an acidic solution to create ahomogeneous suspension of swollen ATM fragments, wherein the acidicsolution has a pH less than 3.0 and does not cause substantialirreversible denaturation of collagen fibers in the ATM; b) applying thehomogeneous suspension to a biocompatible mesh substrate to create acoated mesh substrate; and c) drying the coated substrate to form a meshcomposition. Steps (a) and (b) can be performed simultaneously.

The ATM can be or can include dermis from which all, or substantiallyall, viable cells have been removed. The ATM can include a tissue fromwhich all, or substantially all, viable cells have been removed, whereinthe tissue is selected from the group consisting of fascia, pericardialtissue, dura, umbilical cord tissue, placental tissue, cardiac valvetissue, ligament tissue, tendon tissue, arterial tissue, venous tissue,neural connective tissue, urinary bladder tissue, ureter tissue, andintestinal tissue. The ATM can be made from human tissue or non-humanmammalian tissue. The non-human mammal can be a pig. In one aspect, thenon-human mammal can be genetically engineered to lack expression ofα-1,3-galactosyl residues. The non-human mammal can lack a functionalα-1,3-galactosyltransferase gene. The fragments of ATM can be particlesof ATM.

In one aspect, the pH of the acidic solution can be below about 3.0. ThepH can be from about 1.0 to about 3.0, from about 2.0 to about 3.0 orfrom about 1.5 to about 2.5. The pH can be about 1.4. In another aspect,the acidic solution can be a solution comprising an acid selected fromthe group consisting of acetic acid, ascorbic acid, boric acid, carbonicacid, citric acid, hydrochloric acid, lactic acid, tannic acid,phosphoric acid, and sulfuric acid. The acidic solution can include 0.1M acetic acid. The acidic solution can include 0.04 M hydrochloric acid.

In one aspect, incubation step can be for a period from about 0.5 hoursto about 12 hours. The incubation step can be for a period from about1.0 to about 10.0 hours, from about 2.0 to about 6 hours or from about2.5 to about 5 hours. The incubation step can be for a period of about 3hours.

In one aspect, the incubating, the drying, or the incubating and thedrying can be at a temperature of about 20° C. to about 42° C. Thetemperature can be from about 20° C. to about 30° C., from about 25° C.to about 35° C., from about 30° C. to about 40° C., from about 35° C. toabout 38° C. or from about 37° C. to about 42° C. The temperature can beabout 37° C. The temperature can be about 25° C.

In one aspect, the mesh substrate can be substantially non-absorbable.In another aspect, the mesh substrate can be absorbable. The absorbablemesh can be a polymer selected from the group consisting ofpolyhydroxyalkanoate, polyglycolic acid, poly-1-lactic acid,polylactic/polyglycolic acid (PLGA), polygalactin 910, and carboxymethylcellulose. The polymer can include poly-4-hydroxybutyrate. The meshsubstrate can be a synthetic substrate; the synthetic substrate caninclude polypropylene.

In another aspect, the drying can include drying in a nitrogenatmosphere or freeze-drying.

In another aspect, the method of making a biocompatible mesh compositioncan include: a) incubating a plurality of fragments of a porcineacellular dermal matrix for about 3 hours at a temperature of about 37°C. in an 0.1 M acetic acid solution to create a homogeneous suspensionof swollen fragments, wherein the acidic solution has a pH of about 2.6and does not cause substantial irreversible denaturation of collagenfibers in the porcine acellular dermal matrix; b) applying thehomogeneous suspension to a biocompatible polypropylene mesh substrateto create a coated mesh substrate; and c) drying the coated substrate ina nitrogen atmosphere to form a mesh composition.

In another embodiment, the invention provides a biocompatible meshcomposition made by a) incubating a plurality of fragments of an ATM inan acidic solution to create a homogeneous suspension of swollen ATMfragments, wherein the acidic solution has a pH less than 3.0 and doesnot cause substantial irreversible denaturation of collagen fibers inthe ATM; b) applying the homogeneous suspension to a biocompatible meshsubstrate to create a coated mesh substrate; and c) drying the coatedsubstrate to form a mesh composition. Steps (a) and (b) can be performedsimultaneously.

The ATM can be or can include dermis from which all, or substantiallyall, viable cells have been removed. The ATM can include a tissue fromwhich all, or substantially all, viable cells have been removed, whereinthe tissue is selected from the group consisting of fascia, pericardialtissue, dura, umbilical cord tissue, placental tissue, cardiac valvetissue, ligament tissue, tendon tissue, arterial tissue, venous tissue,neural connective tissue, urinary bladder tissue, ureter tissue, andintestinal tissue. The ATM can be made from human tissue or non-humanmammalian tissue. The non-human mammal can be a pig. In someembodiments, the non-human mammal can be genetically engineered to lackexpression of α-galactosyl residues. The non-human mammal can lack afunctional α-1,3-galactosyltransferase gene. The fragments of ATM can beparticles of ATM.

In one aspect, the pH of the acidic solution can be below about 3.0. ThepH can be from about 1.0 to about 3.0, from about 2.0 to about 3.0 orfrom about 1.5 to about 2.5. The pH can be about 1.4. In another aspect,the acidic solution can be a solution comprising an acid selected fromthe group consisting of acetic acid, ascorbic acid, boric acid, carbonicacid, citric acid, hydrochloric acid, lactic acid, tannic acid,phosphoric acid, and sulfuric acid. The acidic solution can include 0.1M acetic acid. The acidic solution can include 0.04 M hydrochloric acid.

In one aspect, incubation step can be for a period from about 0.5 hoursto about 12 hours. The incubation step can be for a period from about1.0 to about 10.0 hours. The incubation step can be for a period fromabout 2.0 to about 6 hours or from about 2.5 to about 5 hours. Theincubation step can be for a period of about 3 hours.

In one aspect, the incubating, the drying, or the incubating and thedrying can be at a temperature of about 20° C. to about 42° C. Thetemperature can be from about 20° C. to about 30° C., from about 25° C.to about 35° C., from about 30° C. to about 40° C., from about 35° C. toabout 38° C., or from about 37° C. to about 42° C. The temperature canbe about 37° C. The temperature can be about 25° C.

In one aspect, the mesh substrate can be substantially non-absorbable.In another aspect, the mesh substrate can be absorbable. The absorbablemesh can be a polymer selected from the group consisting ofpolyhydroxyalkanoate, polyglycolic acid, poly-1-lactic acid,polylactic/polyglycolic acid (PLGA), polygalactin 910, and carboxymethylcellulose. The polymer can include poly-4-hydroxybutyrate. The meshsubstrate can be a synthetic substrate; the synthetic substrate caninclude polypropylene.

In another aspect, the drying can include drying in a nitrogenatmosphere or freeze-drying.

In another embodiment, a biocompatible mesh composition is provided. Thecomposition includes a coated mesh substrate, wherein the coating on themesh substrate includes a dried ATM suspension. In one aspect, thecomposition includes an ATM suspension including a plurality ofacellular tissue matrix (ATM) fragments swollen in an acidic solution,wherein the acidic solution has a pH less than 3.0 and does not causesubstantial irreversible denaturation of collagen fibers in the ATM, andwherein the ATM fragments are incubated at a temperature of about 30° C.to about 42° C.

The ATM can be or can include dermis from which all, or substantiallyall, viable cells have been removed. The ATM can include a tissue fromwhich all, or substantially all, viable cells have been removed, whereinthe tissue is selected from the group consisting of fascia, pericardialtissue, dura, umbilical cord tissue, placental tissue, cardiac valvetissue, ligament tissue, tendon tissue, arterial tissue, venous tissue,neural connective tissue, urinary bladder tissue, ureter tissue, andintestinal tissue. The ATM can be made from human tissue or non-humanmammalian tissue. The non-human mammal can be a pig. In someembodiments, the non-human mammal can be genetically engineered to lackexpression of α-galactosyl residues. The non-human mammal can lack afunctional α-1,3-galactosyltransferase gene. The fragments of ATM can beparticles of ATM.

In one aspect, the pH can be below about 3.0. The pH can be from about1.0 to about from about 2.0 to about 3.0 or from about 1.5 to about 2.5.The pH can be about 1.4. In another aspect, the acidic solution can be asolution comprising an acid selected from the group consisting of aceticacid, ascorbic acid, boric acid, carbonic acid, citric acid,hydrochloric acid, lactic acid, tannic acid, phosphoric acid, andsulfuric acid. The acidic solution can include 0.1 M acetic acid. Theacidic solution can include 0.04 M hydrochloric acid.

In one aspect, incubation step can be for a period from about 0.5 hoursto about 12 hours. The incubation step can be for a period from about1.0 to about 10.0 hours. The incubation step can be for a period fromabout 2.0 to about 6 hours or from about 2.5 to about hours. Theincubation step can for a period of about 3 hours.

In one aspect, the incubating, the drying, or the incubating and thedrying can be at a temperature of about 20° C. to about 42° C. Thetemperature can be from about 20° C. to about 30° C., from about 25° C.to about 35° C., from about 30° C. to about 40° C., from about 35° C. toabout 38° C., or from about 37° C. to about 42° C. The temperature canbe about 37° C. The temperature can be about 25° C.

In one aspect, the mesh substrate can be substantially non-absorbable.In another aspect, the mesh substrate can be absorbable. The absorbablemesh can be a polymer selected from the group consisting ofpolyhydroxyalkanoate, polyglycolic acid, poly-1-lactic acid,polylactic/polyglycolic acid (PLGA), polygalactin 910, and carboxymethylcellulose. The polymer can include poly-4-hydroxybutyrate. The meshsubstrate can be a synthetic substrate; the synthetic substrate caninclude polypropylene.

In another aspect, the drying can include drying in a nitrogenatmosphere or freeze-drying.

In another embodiment, a method of ameliorating or repairing an organ ortissue is provided. The method includes a) identifying a mammaliansubject as having an organ or tissue in need of amelioration or repair;and b) placing any of the above-described biocompatible meshcompositions in or on the organ or tissue. The mammalian subject can behuman. The recipient organ or tissue can be selected from the groupconsisting of abdominal wall tissue, abdominal muscle, and smooth muscletissue. The subject can have a defect in need of repair selected fromthe group consisting of an inguinal hernia, a femoral hernia, a ventralhernia, an abdominal hernia, an incisional hernia, a hiatal hernia, adiaphragmatic hernia, an umbilical hernia, fascial weakness in thechest, fascial weakness in the abdominal wall, and pelvic organprolapse.

In another embodiment, articles of manufacture are provided. An articleof manufacture can include a biocompatible mesh composition including acoated mesh substrate, wherein the coating on the mesh substrateincludes a dried ATM suspension; and packaging material, or a packageinsert, comprising instructions for a method of ameliorating orrepairing an organ or tissue. The method can include i) identifying amammalian subject as having a recipient organ or tissue in need ofamelioration or repair; and ii) placing the biocompatible meshcomposition in or on the organ or tissue.

In another embodiment, a method of making a biocompatible dermal filmcomposition is provided. The method can include swelling a plurality offragments of an acellular tissue matrix (ATM) in an acidic solution tocreate a homogeneous suspension, wherein the acidic solution has a pHless than 3.0 and does not cause substantial irreversible denaturationof collagen fibers in the ATM; incubating the homogeneous suspension ofATM at a temperature of about 20° C. to about 42° C.; and drying thehomogeneous suspension to form a dermal film composition.

In the above described methods, compositions and articles ofmanufacture, the recited embodiments can be combined in any combinationdesired.

Unless otherwise defined, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention pertains. Although methods and materialssimilar or equivalent to those described herein can be used in thepractice or testing of the present invention, suitable methods andmaterials are described below. All publications, patent applications,patents, and other references mentioned herein are incorporated byreference in their entirety. In case of conflict, the presentspecification, including definitions, will control. In addition, thematerials, methods, and examples are illustrative only and not intendedto be limiting.

The details of one or more embodiments of the invention are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the invention will be apparent from thedescription and drawings, and from the claims.

DETAILED DESCRIPTION

The materials and methods provided herein can be used to make abiocompatible tissue repair composition that can be implanted into an adamaged or defective organ or tissue to facilitate the repair of thedamaged or defective organ or tissue. As used herein, a “biocompatible”composition is one that has the ability to support cellular activitynecessary for complete or partial tissue regeneration, but does notstimulate a significant local or systemic inflammatory or immunologicalresponse in the host. As used herein, a “significant local or systemicinflammatory or immunological response in the host” is a local orsystemic inflammatory or immunological response that partially orcompletely prevents tissue regeneration by a composition of theinvention.

I. Composition Components

The composition of the invention is made by swelling ATM fragments in anacidic solution and then drying the resulting swollen ATM fragmentsuspension, preferably onto one surface, or both surfaces, of a meshsubstrate. The coating of implantable medical devices with thecompositions provided herein in order to attenuate a foreign bodyresponse is also contemplated. Examples of suitable devices include,without limitation, artificial joints, vascular grafts, artificialvalves, cardiac pacemakers, cardiac defibrillators, muscle stimulators,neurological stimulators, cochlear implants, monitoring devices, drugpumps and left ventricular assist devices.

Acellular Tissue Matrices

As used herein, an “acellular tissue matrix” (“ATM”) is a tissue-derivedstructure that is made from any of a wide range of collagen-containingtissues by removing all, or substantially all, viable cells and,preferably, all detectable dead cells, subcellular components and/ordebris generated by dead or dying cells. As used herein, an “acellularmatrix” is a matrix that: (a) is made from any of a wide range ofcollagen-based tissues; (b) is acellular; and (c) retains the biologicaland structural functions possessed by the native tissue or organ fromwhich it was made. Biological functions retained by matrices includecell recognition and cell binding as well as the ability to support cellspreading, cell proliferation, and cell differentiation. Such functionsare provided by undenatured collagenous proteins (e.g., type I collagen)and a variety of non-collagenous molecules (e.g., proteins that serve asligands for either molecules such as integrin receptors, molecules withhigh charge density such glycosaminoglycans (e.g., hyaluronan) orproteoglycans, or other adhesins). Structural functions retained byuseful acellular matrices include maintenance of histologicalarchitecture, maintenance of the three-dimensional array of the tissue'scomponents and physical characteristics such as strength, elasticity,and durability, defined porosity, and retention of macromolecules. Theefficiency of the biological functions of an acellular matrix can bemeasured, for example, by its ability to support cell proliferation andis at least 50% (e.g., at least: 50%; 60%; 70%; 80%; 90%; 95%; 98%; 99%;99.5%; 100%; or more than 100%) of those of the native tissue or organfrom which the acellular matrix is made. In addition, the integrity ofthe basement membrane in the acellular matrices, as measured by electronmicroscopy and/or immunohistochemistry, is at least 70% of that of thenative tissue or organ from which the acellular matrix is made. As usedherein, an ATM lacking “substantially all viable cells” is an ATM inwhich the concentration of viable cells is less than 1% (e.g., lessthan: 0.1%; 0.01%; 0.001%; 0.0001%; 0.00001%; 0.000001%; or 0.0%) ofthat in the tissue or organ from which the ATM was made. The ATM usefulfor the invention are preferably also substantially lack dead cellsand/or cell debris that may be present after killing the cells in theATM. An ATM “substantially lacking dead cells and/or cell debris” is onethat contains less than 10% (i.e., less than: 8%; 5%; 1%; 0.1%; 0.001%;0.0001%; or less) of the dead cells and/or cell debris present in theATM following a cell removal process.

ATM made from dermis are referred to herein in some instances as“acellular dermal matrices” (“ADM”).

The ATM of the invention can have or lack an epithelial basementmembrane. The epithelial basement membrane is a thin sheet ofextracellular material contiguous with the basilar aspect of epithelialcells. Sheets of aggregated epithelial cells form an epithelium. Thus,for example, the epithelium of skin is called the epidermis, and theskin epithelial basement membrane lies between the epidermis and thedermis. The epithelial basement membrane is a specialized extracellularmatrix that provides a barrier function and an attachment surface forepithelial-like cells; however, it does not contribute any significantstructural or biomechanical role to the underlying tissue (e.g.,dermis). Unique components of epithelial basement membranes include, forexample, laminin, collagen type VII, and nidogen. The unique temporaland spatial organization of the epithelial basement membrane distinguishit from, e.g., the dermal extracellular matrix. In some embodiments, thepresence of the epithelial basement membrane in an ATM could bedisadvantageous in that the epithelial basement membrane can contain avariety of species-specific components that could elicit the productionof antibodies, and/or bind to preformed antibodies, in xenogeneic graftrecipients of the acellular matrix. In addition, the epithelial basementmembrane can act as barrier to diffusion of cells and/or soluble factors(e.g., chemoattractants) and to cell infiltration. Its presence in anATM can thus significantly delay formation of new tissue from the ATM ina recipient animal. As used herein, an ATM that “substantially lacks” anepithelial basement membrane is an acellular tissue matrix containingless than 5% (e.g., less than: 3%; 2%; 1%; 0.5%; 0.25%; 0.1%; 0.01%;0.001%; or even less than 0.001%) of the epithelial basement membranepossessed by the corresponding unprocessed tissue from which the ATM wasderived.

The ATM retain the biological and structural attributes of the tissuesfrom which they are made, including cell recognition and cell binding aswell as the ability to support cell spreading, cell proliferation, andcell differentiation. Such functions are provided by undenaturedcollagenous proteins (e.g., type I collagen) and a variety ofnon-collagenous molecules (e.g., proteins that serve as ligands foreither molecules such as integrin receptors, molecules with high chargedensity such glycosaminoglycans (e.g., hyaluronan) or proteoglycans, orother adhesins). Structural functions retained by useful ATM includemaintenance of histological architecture, maintenance of thethree-dimensional array of the tissue's components and physicalcharacteristics such as strength, elasticity, and durability, definedporosity, and retention of macromolecules. The efficiency of thebiological functions of an ATM can be measured, for example, by theability of the ATM to support cell (e.g., epithelial cell) proliferationand is at least 30% (e.g., at least: 40%; 50%; 60%; 70%; 80%; 90%; 95%;98%; 99%; 99.5%; 100%; or more than 100%) of that of the native tissueor organ from which the ATM is made. It is not necessary that the ATM bemade from tissue that is identical to the surrounding host tissue butshould simply be amenable to being remodeled by invading or infiltratingcells such as differentiated cells of the relevant host tissue, stemcells such as mesenchymal stem cells, or progenitor cells. It isunderstood that the ATM can be produced from any collagen-containingsoft tissue and muscular skeleton (e.g., dermis, fascia, pericardium,dura, umbilical cords, placentae, cardiac valves, ligaments, tendons,vascular tissue (arteries and veins such as saphenous veins), neuralconnective tissue, urinary bladder tissue, ureter tissue, or intestinaltissue), as long as the above-described properties are retained by thematrix.

An ATM useful for the invention can optionally be made from arecipient's own collagen-based tissue. Furthermore, while an ATM willgenerally have been made from one or more individuals of the samespecies as the recipient of the tissue repair composition, this is notnecessarily the case. Thus, for example, an ATM can have been made froma porcine tissue and be used to make a tissue repair composition thatcan be implanted in a human patient. Species that can serve asrecipients of a tissue repair composition and donors of tissues ororgans for the production of the ATM component of the tissue repaircomposition can include, without limitation, mammals, such as humans,non-human primates (e.g., monkeys, baboons, or chimpanzees), pigs, cows,horses, goats, sheep, dogs, cats, rabbits, guinea pigs, gerbils,hamsters, rats, or mice. Moreover, different breeds of animals within aspecies (e.g., Yucatan mini-pigs or Yorkshire pigs) can be used.

Of particular interest as donors are animals (e.g., pigs and cows) thathave been genetically engineered to lack the terminal galactose-α-1,3-galactose moiety. For descriptions of appropriate animals, seeco-pending U.S. Published Application No. 2005/0028228 Al and U.S. Pat.No. 6,166,288, the disclosures of which are incorporated herein byreference in their entirety. A major problem of xenotransplantation inrecipient animals (e.g., humans) that do not express the enzymeUDP-galactose:β-D-galactosyl-1,4-N-acetyl-D-glucosaminide α-1,3galactosyl-transferase (α-1,3 galactosyltransferase; “α-GT”) thatcatalyzes the formation of the terminal disaccharide structure,galactose α-1,3 galactose (“α-gal”), is the hyperacute rejection ofxenografts in such recipients. This rejection is largely, if notexclusively, due to the action of antibodies specific for the α-galepitope on the surface of cells in the xenograft. Transgenic animals(e.g., pigs and cows) have been derived which lack, or substantiallylack, functional α-GT and thus also lack, or substantially lack, α-galepitopes.

Methods of making transgenic animals, and in particular gene-disruptedtransgenic animals, are well known in the art. Methods of makinggene-disrupted animals involve, for example, incorporating a disruptedform of a gene of interest into the germline of an individual of aspecies. The gene can be disrupted so that no protein product (e.g.,α-GT) is produced or a protein product is produced that lacks theactivity, or substantially lacks the activity, of the native protein. Asused herein, a α-GT protein “substantially lacking α-GT activity” is anα-GT protein that has less than 5% (e.g., less than: 4%; 2%; 1%; 0.1%;0.01%; 0.001%; or even less than 0.001%) of the ability of wild-typeα-GT to generate α-gal epitopes. Methods of disrupting genes, and inparticular, the α-GT gene, are known in the art and generally involvethe process known as homologous recombination. In this process, one orboth copies of a wild-type gene of interest can be disrupted byinserting a sequence into the wild-type gene(s) such that no transcriptis produced from the gene(s); or a transcript is produced from which noprotein is translated; or a transcript is produced that directs thesynthesis of a protein that lacks, or substantially lacks, thefunctional activity of the protein of interest. Such constructstypically include all or part of the genomic sequence of the gene ofinterest and contain, within that genomic sequence, a sequence that willdisrupt expression of the gene of interest in one of the ways describedabove. The sequence used to disrupt expression of the gene can be asequence encoding a protein that confers antibiotic resistance (e.g.,neomycin resistance) on target cells that have incorporated theconstruct into their genomes. Such a coding sequence facilitates the invitro selection of cells that have incorporated the genetic constructinto their genomes. Additional drug selection methodologies known in theart can be used to select cells in which recombination between theconstruct and at least one copy of the targeted gene has occurred.

In some methods of generating gene disrupted animals, totipotent cells(i.e., cells capable of giving rise to all cell types of an embryo) canbe used as target cells. Such cells include, for example embryonic stem(ES) cells (in the form of ES cell lines) or fertilized eggs (oocytes).A population of ES cells in which at least one copy of the gene ofinterest is disrupted can be injected into appropriate blastocysts andthe injected blastocysts can be implanted into foster mothers.Alternatively, fertilized eggs injected with the gene-disruptingconstruct of interest can be implanted in the foster mothers. Moreover,oocytes implanted in foster mothers can be those that have beenenucleated and injected with nuclei from successfully gene-disrupted EScells [Campbell et al, (1996) Nature 380: 64-66]. Resultingmutation-containing offspring arising in such mother foster mothers canbe identified and, from these founder animals, distinct animal lines canbe produced using breeding and selection methods known to those in theart.

Standard and gene-disrupted transgenic animals can also be producedusing somatic cells (e.g., fetal fibroblasts) as target cells for thegene-disruption. Such cells grow much faster and are more easily handledin vitro than, for example, ES cells, thus facilitating the genedisruption and subsequent gene-disrupted cell selection procedures. Oncea line of gene-disrupted somatic cells has been selected in vitro,nuclei from the gene-disrupted somatic cells can be incorporated intototipotent cells (e.g., ES cells or oocytes), which are then handled asdescribed above. Methods for nuclear transplantation are known to thosein the art and can include techniques such as, for example, cell fusionor nuclear transplantation.

Most commonly, the gene disruption procedures result in disruption ofonly one allele of a gene of interest. In these cases, the transgenicanimals will be heterozygous for the disrupted gene. Breeding of suchheterozygotes and appropriate selection procedures familiar to those inthe art can then be used to derive animals that are homozygous for thedisrupted gene. Naturally, such breeding procedures are not necessarywhere the gene disruption procedure described above resulted indisruption of both alleles of the gene of interest.

As an alternative to the use of genetically engineered animals, specificenzymatic treatments may be used for removal of the terminalgalactose-α-1,3-galactose. Enzymatic treatment of ATM with anα-1,3-galactosidase can be performed using a specific glycosidase thathas α-1,3-galactosidase activity, for example, coffee beanα-1,3-glactosidase. This enzyme can be derived from either naturalsources or produced using the Pichia pastoris expression system or anyother recombinant system capable of producing a functionalα-1,3-glalactosidase.

For the production of tissue repair composition, ATM in the form offragments (i.e., particles, threads or fibers) are generally used (seebelow). The ATM can be produced by any of a variety of methods. All thatis required is that the steps used in their production result inmatrices with the above-described biological and structural properties.Particularly useful methods of production include those described inU.S. Pat. Nos. 4,865,871; 5,366,616; 6,933,326 and copending U.S.Published Application Nos. 2003/0035843 A1, and 2005/0028228 A1, all ofwhich are incorporated herein by reference in their entirety.

In brief, the steps involved in the production of an ATM generallyinclude harvesting the tissue from a donor (e.g., a human cadaver or anyof the above-listed mammals), chemical treatment so as to stabilize thetissue and avoid biochemical and structural degradation together with,or followed by, cell removal under conditions which similarly preservebiological and structural function. The ATM can optionally be treatedwith a cryopreservation agent and cryopreserved and, optionally,freeze-dried, again under conditions necessary to maintain the describedbiological and structural properties of the matrix. After freezing orfreeze drying, the tissue can be fragmented, e.g., pulverized ormicronized to produce a particulate ATM under similarfunction-preserving conditions. All steps are generally carried outunder aseptic, preferably sterile, conditions.

An exemplary method of producing ATM, which is described in greaterdetail in U.S. Pat. No. 5,366,616, is summarized below.

After removal from the donor, the tissue is placed in an initialstabilizing solution. The initial stabilizing solution arrests andprevents osmotic, hypoxic, autolytic, and proteolytic degradation,protects against microbial contamination, and reduces mechanical damagethat can occur with tissues that contain, for example, smooth musclecomponents (e.g., blood vessels). The stabilizing solution generallycontains an appropriate buffer, one or more antioxidants, one or moreoncotic agents, one or more antibiotics, one or more proteaseinhibitors, and in some cases, a smooth muscle relaxant.

The tissue is then placed in a processing solution to remove viablecells (e.g., epithelial cells, endothelial cells, smooth muscle cells,and fibroblasts) from the structural matrix without damaging thebasement membrane complex or the biological and structural integrity ofthe collagen matrix. The processing solution generally contains anappropriate buffer, salt, an antibiotic, one or more detergents, one ormore agents to prevent cross-linking, one or more protease inhibitors,and/or one or more enzymes.

An appropriate buffer can be an organic buffer, for example,2-(N-morpholino)ethanesulfonic acid (MES),3-(N-morpholine)propanesulfonic acid (MPOS) andN-2-hydroxyethylpiperazine-N¹-2-ethane-sulfonic acid (HEPES).Alternatively, a low salt or physiological buffer, including phosphate,bicarbonate and acetate-citrate, may be more appropriate in certainapplications. Salts can include common physiologic salts such as sodiumchloride or potassium chloride. Antibiotics can include, for example,penicillin, streptomycin, gentamicin kanamycin, neomycin, bacitracin,and vancomycin. Additionally, anti-fungal agents may be employed,including amphotericin-B, nystatin, and polymyxin. Suitable detergentsinclude without limitation, for example, sodium deoxycholate,Triton-X-100™ (Rohm and Haas, Philadelphia, Pa.), polyoxyethylene (20)sorbitan mono-oleate (Tween 20); polyoxyethylene (80) sorbitanmono-oleate (Tween 80); 3-[(3-chloramidopropyl)-dimethylamino]-1-propanesulfonate; octyl glucoside; and sodium dodecyl sulfate. Agents thatinhibit or prevent the formation of cross-links can includeethylenediaminetetraacetic acid (EDTA), ascorbic acid and other freeradical scavengers. Examples of useful protease inhibitors include,without limitation, N-ethylmaleimide (NEM), phenylmethylsulfonylfluoride (PMSF), ethylenediaminetetraacetic acid (EDTA), ethyleneglycol-bis (2-aminoethyl ether)-N,N,N¹,N¹-tetraacetic acid (EGTA),leupeptin, ammonium chloride, elevated pH and apoprotinin. Examples ofuseful enzymes include, without limitation, dispase II, trypsin, andthermolysin. In some embodiments, an osmotic balancing agent can beincluded in the processing solution to provide a colloid osmotic balancebetween the solution and the tissue, thus preventing the diffusion ofendogenous proteoglycans from the tissue to the solution. The osmoticbalancing agent can be, for example, without limitation, a proteoglycan,e.g., chondroitin sulfate, heparin sulfate, or dermatan sulfate, or apolymer, e.g., dextran or polyvinyl pyrolodone (PVP), or an amino acid,e.g., glycine or valine.

Treatment of the tissue must be with a processing solution containingactive agents at a concentration and for a time period such that, afterprocessing, the tissue retains the biological and structural attributesof the native unprocessed tissue (see the above description of ATM).

After decellularization, the tissue can be frozen (i.e., cryopreserved)and optionally, freeze-dried. Before freezing, the tissue can beincubated in a cryopreservation solution. This solution generallycontains one or more cryoprotectants to minimize ice crystal damage tothe structural matrix that could occur during freezing. Examples ofuseful cryoprotectants are provided in U.S. Pat. No. 5,336,616. If thetissue is to be freeze-dried, the solution will generally also containone or more dry-protective components, to minimize structural damageduring drying and may include a combination of an organic solvent andwater which undergoes neither expansion or contraction during freezing.The cryoprotective and dry-protective agents can be the same one or moresubstances. If the tissue is not going to be freeze-dried, it can befrozen by placing it (in a sterilized container) in a freezer at about−80° C., or by plunging it into sterile liquid nitrogen, and thenstoring at a temperature below −160° C. until use. The sample can bethawed prior to use by, for example, immersing a sterile non-permeablevessel (see below) containing the sample into a water bath at about 37°C. or by allowing the tissue to come to room temperature under ambientconditions.

If the tissue is to be frozen and freeze-dried, following incubation inthe cryopreservation solution, the tissue can be packaged inside asterile vessel that is permeable to water vapor yet impermeable tobacteria, e.g., a water vapor permeable pouch or glass vial. One side ofa preferred pouch consists of medical grade porous TYVEK® membrane, atrademarked product of DuPont Company of Wilmington, Del. This membraneis porous to water vapor and impervious to bacteria and dust. The TYVEK®membrane is heat sealed to an impermeable polythylene laminate sheet,leaving one side open, thus forming a two-sided pouch. The open pouch issterilized by irradiation (e.g., γ-irradiation) prior to use. The tissueis aseptically placed (through the open side) into the sterile pouch.The open side is then aseptically heat sealed to close the pouch. Thepackaged tissue is henceforth protected from microbial contaminationthroughout subsequent processing steps.

The vessel containing the tissue is cooled to a low temperature at aspecified rate which is compatible with the specific cryoprotectantformulation to minimize the freezing damage. See U.S. Pat. No. 5,336,616for examples of appropriate cooling protocols. The tissue is then driedat a low temperature under vacuum conditions, such that water vapor isremoved sequentially from each ice crystal phase.

At the completion of the drying of the samples in the water vaporpermeable vessel, the vacuum of the freeze drying apparatus is reversedwith a dry inert gas such as nitrogen, helium or argon. While beingmaintained in the same gaseous environment, the semipermeable vessel isplaced inside an impervious (i.e., impermeable to water vapor as well asmicroorganisms) vessel (e.g., a pouch) which is further sealed, e.g., byheat and/or pressure. Where the tissue sample was frozen and dried in aglass vial, the vial is sealed under vacuum with an appropriate inertstopper and the vacuum of the drying apparatus reversed with an inertgas prior to unloading. In either case, the final product ishermetically sealed in an inert gaseous atmosphere. The freeze-driedtissue may be stored under refrigerated conditions until fragmentationor, if desired, rehydration.

ATM fragments are either particles (particulate), fibers, or threads.

Particulate ATM have a generally spherical or even irregular shape, withthe longest dimension being not greater than 1000 microns. ParticulateATM can be made from any of the above described non-particulate ATM byany process that results in the preservation of the biological andstructural functions described above and, in particular, damage tocollagen fibers, including sheared fiber ends, should be minimized

One appropriate method for making particulate ATM is described in U.S.Pat. No. 6,933,326, the disclosure which is herein incorporated hereinby reference in its entirety. The process is briefly described belowwith respect to a freeze-dried dermal ATM (acellular dermal matrix; ADM)but one of skill in the art could readily adapt the method for use withfrozen or freeze-dried ATM derived from any of the other tissues listedherein.

The ADM can be cut into strips (using, for example, a Zimmer mesherfitted with a non-interrupting “continuous” cutting wheel). Theresulting long strips are then cut into lengths of about 1 cm to about 2cm. A homogenizer and sterilized homogenizer probe (e.g., a LabTeckMacro homogenizer available from OMNI International, Warrenton, Va.) isassembled and cooled to cryogenic temperatures (i.e., about −196° C. toabout −160° C.) using sterile liquid nitrogen which is poured into thehomogenizer tower. Once the homogenizer has reached a cryogenictemperature, cut pieces of ADM are added to the homogenizing towercontaining the liquid nitrogen. The homogenizer is then activated so asto cryogenically fracture the pieces of ADM. The time and duration ofthe cryogenic fracturing step depends upon the homogenizer utilized, thesize of the homogenizing chamber, and the speed and time at which thehomogenizer is operated, and are readily determinable by one skilled inthe art. As an alternative, the cryofracturing process can be conductedin cryomill cooled to a cryogenic temperature.

The cryofractured particulate ATM is, optionally, sorted by particlesize by washing the product of the homogenization with sterile liquidnitrogen through a series of metal screens that have also been cooled toa cryogenic temperature. It is generally useful to eliminate largeundesired particles with a screen with a relatively large pore sizebefore proceeding to one (or more screens) with a smaller pore size.Once isolated, the particles can be freeze-dried to ensure that anyresidual moisture that may have been absorbed during the procedure isremoved. The final product is a powder (usually white or off-white)generally having a particle size of about 1 micron to about 900 microns,about 30 microns to about 750 microns, or about 150 to about 300microns.

ATM fragments can also be fibers or threads. Such fibers or threadswould generally not be greater than 5 cm (e.g., not greater than: 4.5cm; 4.0 cm; 3.5 cm; 3.0 cm; 2.5 cm; 2.0 cm; 1.5 cm; 1.0 cm; 0.5 cm; 0.25cm; 0.1 cm; 0.05 cm; or 0.02 cm) in length and not greater than 3 mm(e.g., not greater than: 2.5 mm; 2.0 mm; 1.5 mm; 1.0 mm; 0.5 mm; 0.2 mm;0.1 mm; 0.05 mm; 0.02 mm; or 0.01 mm) at their widest point. Methods ofproducing fibers and threads from frozen or freeze-dried ATM would beapparent to those skilled in the art and include both manual or machinecutting of the frozen or freeze-dried ATM.

One highly suitable freeze-dried ATM is produced from human dermis bythe LIFECELL® CORPORATION (Branchburg, N.J.) and marketed in the form ofsmall sheets as ALLODERM®. Such sheets are marketed by the LIFECELL®CORPORATION as rectangular sheets with the dimensions of, for example, 1cm×2 cm, 3 cm×7 cm, 4 cm×8 cm, 5 cm×10 cm, 4 cm×12 cm, and 6 cm×12 cm.The cryoprotectant used for freezing and drying AlloDerm® is a solutionof 35% maltodextrin and 10 mM ethylenediaminetetraacetate (EDTA). Thus,the final dried product contains about 60% by weight ATM and about 40%by weight maltodextrin. The LIFECELL® CORPORATION also makes ananalogous product from porcine dermis (designated XenoDerm™) having thesame proportions of ATM and maltodextrin as ALLODERM®. In addition, theLIFECELL® CORPORATION markets a particulate acellular dermal matrix madeby cryofracturing AlloDerm® (as described above) under the nameCYMETRA®. The particle size for CYMETRA® is in the range of about 60microns to about 150 microns as determined by mass. The particles ofparticulate or pulverized (powdered) ATM will be less than 1.0 mm intheir longest dimension. Pieces of ATM with dimensions greater than thisare non-particulate acellular matrices.

Mesh Substrates

In some embodiments, the biocompatible tissue repair composition caninclude a mesh substrate. Any biocompatible mesh substrate, e.g., asurgical mesh, can be used. Surgical mesh substrates are multifilamentwoven materials that are available in many forms and have been producedfrom a variety of synthetic and natural materials. Meshes can be broadlyclassified according to filament structure, pore size and weight.Filament structure can be monofilament, multifilament or multifilamentfibers formed from monofilament materials. Mesh pore sizes can rangefrom between about 200 n to about 5000 Small pore sizes, e.g., 1000μ orless, are typical of heavyweight meshes, while larger pore sizes, e.g.,greater than 1000μ are characteristic of lightweight meshes. Mesh weightis expressed as g/m², with heavyweight meshes having densities of about80-100 g/m² and lightweight meshes having densities in the range of25-45 g/m².

The mesh substrate can be made of a non-absorbable material, anabsorbable material or a material that is a combination of bothnon-absorbable and absorbable materials. “Absorbable material” isdefined herein as any material that can be degraded in the body of amammalian recipient by endogenous enzymatic or cellular processes.Depending upon the particular composition of the material, thedegradation products can be recycled via normal metabolic pathways orexcreted through one or more organ systems. Naturally, a “nonabsorbablematerial” is one that cannot be degraded in the body of a mammalianrecipient by endogenous enzymatic or cellular processes.

Polymers used to make non-absorbable meshes include polypropylene,polyester, i.e., polyethylene terephthalate, or polytetrafluoroethylene(PTFE). Examples of commercially available polypropylene meshes include:MARLEX™(CR Bard, Inc., Cranston R.I.), VISILEX® (CR Bard, Inc., CranstonRI), PERFIX® Plug (CR Bard, Inc., Cranston R.I.), KUGEL™ Hernia Patch(CR Bard, Inc., Cranston R.I.), 3DMAX® (CR Bard, Inc., Cranston R.I.),PROLENE™ (Ethicon, Inc., Somerville, N.J.), SURGIPRO™ (Autosuture,U.S.Surgical, Norwalk, Conn.), Prolite™ (Atrium Medical Co., Hudson,N.H.), PROLITE ULTRATM (Atrium Medical Co., Hudson, N.H.), TRELEX™(Meadox Medical, Oakland, N.J.), and PARIETENE® (Sofradim,Trevoux,France). Examples of commercially available polyester meshesinclude MERSILENE™ (Ethicon, Inc., Somerville, N.J.) and PARIETEX®(Sofradim, Trevoux, France). Examples of commercially available PTFEmeshes include GORETEX® (W.L.Gore & Associates, Newark, Del.), DUALMESH®(W.L.Gore & Associates, Newark, Del.), DUALMESH® Plus(W.L.Gore &Associates, Newark, Del.), DULEX® (CR Bard, Inc., Cranston R.I.), andRECONIX® (CR Bard, Inc., Cranston R.I.).

Absorbable meshes are also available from commercial sources. Polymersused to make absorbable meshes can include polyglycolic acid (DEXON™,SYNETURE™, U.S.Surgical, Norwalk, Conn.), poly-I-lactic acid,polyglactin 910 (VICRYL™, Ethicon, Somerville, N.J.), orpolyhydroxylalkaoate derivatives such as poly-4-hydroxybutyrate (Tepha,Cambridge, Mass.).

Composite meshes, i.e., meshes that include both absorbable andnon-absorbable materials can be made either from combinations of thematerials described above or from additional materials. Examples ofcommercially available composite meshes include polypropylene/PTFE:COMPOSIX® (CR Bard, Inc., Cranston R.I.), COMPOSIX® E/X (CR Bard, Inc.,Cranston R.I.), and VENTRALEX® (CR Bard, Inc., Cranston RI);polypropylene/cellulose: PROCEED™ (Ethicon, Inc., Somerville, N.J.);polypropylene/SEPRAFILM®: SEPRAMESH® (Genzyme, Cambridge, Mass.),SEPRAMESH® IP (Genzyme, Cambridge, Mass.); polypropylene/Vicryl: VYPRO™(Ethicon, Somerville, N.J.), VYPROTM II (Ethicon, Somerville, N.J.);polypropylene/Monocryl(poliglecaprone): ULTRAPRO® (Ethicon, Somerville,N.J.); and polyester/collagen: PARIETEX® Composite (Sofradim, Trevoux,France).

II. Tissue Repair Composition Preparation

The biocompatible tissue repair composition provided herein is made byswelling ATM fragments in an acid solution to create a homogeneoussuspension of swollen ATM particles and the suspension is dried toproduce a collagen film or sponge-like structure. Typically, the volumeoccupied by swollen ATM fragments is increased relative to the volumeoccupied by the same mass of ATM fragments that have not been swollen.In some embodiments, the swelling can be carried out at mildly elevatedtemperatures. The ATM can be in the form of fragments, i.e., particles,fibers or threads. Prior to swelling, the ATM can be washed to removeany residual cryoprotectant. Solutions used for washing can be anyphysiologically compatible solution; highly suitable washing solutionsare, for example, deionized or distilled water, or phosphate bufferedsaline (PBS).

The ATM can be swollen in any acid solution that maintains the ATMfragments as a homogeneous suspension, and that does not result insubstantial irreversible denaturation of the collagen fibers in the ATM.As defined herein, a homogeneous suspension of ATM particles is one inwhich the ATM particles are uniformly distributed in a liquid medium andthat does not contain particulates that are larger than about 1000μ insize, e.g., larger than about 950μ, about 975μ, about 1000μ, about1025μ, about 1050μ, about 1075μ, about 1100μ or more. As used herein,“substantial irreversible denaturation” refers generally to thedissociation of collagen fibrils into their constituent subfibrilsand/or collagen molecules, such that the collagen subfibrils and/ormolecules are substantially unable to refold and reassemble into nativecollagen fibrils. As used herein, in collagen subfibrils and/ormolecules that are “substantially unable to refold and reassemble intonative collagen fibrils”, not more than 30% (e.g., not more than: 25%;20%; 15%; 10%; 5%; 2%; 1%; 0.1%; 0.01%; or less) of the collagensubfibrils and/or molecules are able refold and reassemble into nativecollagen fibrils. The native collagen fibril is a bundle of manysubfibrils, each of which in tum is a bundle of microfibrils. Amicrofibril consists of helically coiled collagen molecules, eachconsisting of three helical polypeptide chains. This arrangement of thecollagen molecules within the collagen fibrils results in acharacteristic 64-67 nm banding periodicity. Typically, irreversiblydenatured collagen fibrils lack, or substantially, lack the bandingperiodicity found in the native collagen fibril. Substantialirreversible denaturation of collagen fibrils can be monitored by anymethod known to those of skill in the art, including, for example, butnot limited to, transmission electron microscopy, scanning electronmicroscopy, and atomic force microscopy or biochemical or enzymaticmethods, e.g., polyacrylamide gel electrophoresis or susceptibility toenzymatic cleavage by collagenase, pepsin or proteinase K. Thus, the ATMmay be swollen in any acid solution that does not result in asubstantial loss of banding periodicity.

It will be appreciated that the type of acid, concentration of acid, thelength of swelling time, and the swelling temperature may be adjusted toachieve optimal swelling of the ATM. For example, ATM from differentsources, e.g., different mammalian species or different strains orbreeds of the same species, may require different swelling conditions inorder to achieve optimal swelling without substantial irreversibledenaturation of the collagen fibrils in the ATM.

An acid is a molecule that acts as a proton donor and thus increases theH⁺ concentration of a solution. Acids that readily give up protons towater are strong acids, while those with only a slight tendency to giveup protons are weak acids. A useful index of the H⁺ ion concentration ina solution is the pH scale; an aqueous solution with a pH of less than 7is considered to be acidic. Thus, the ATM fragments can be swollen inany aqueous solution having a pH below 7.0, e.g., 6.9, 6.5, 6.2, 6.0.5.5, 5.0,4.5,4.0, 3.5, 3.0, 2.8, 2.6, 2.4, 2.2, 2.0, 0.8, 1.6, 1.5, 1.4,1.3, 1.2,1.0 and below. The pH will preferably be below 3.0. “About”indicates that the pH can vary by up to 0.2 pH units above or below therecited value. Thus, a pH of “about” 3.0, can include, for example, pH2.8, 2.85, 2.90, 2.95, 3.0, 3.5, 3.10, 3.15, or 3.20. Examples of usefulacids include acetic acid, ascorbic acid, boric acid, carbonic acid,citric acid, hydrochloric acid, lactic acid, phosphoric acid, sulfuricacid, tannic acid and trichloroacetic acid. Any combination of two ormore acids can also be used.

The specific concentration of acid will depend in part, upon therelative strength of the acid, with stronger acids, e.g., hydrochloricacid or sulfuric acid, requiring lower concentrations and weaker acids,e.g., acetic acid, citric acid and lactic acid, requiring higherconcentrations. Thus, the concentration and lower pH limit forincubation will vary from acid to acid. In some embodiments, the acid isa volatile acid, i.e., an acid that readily evaporates at normaltemperatures and pressures. Appropriate concentrations and pH's arethose that do not result in substantial irreversible denaturation of thecollagen fibers of the ATM (see above).

One highly suitable acid is acetic acid. Acetic acid can be used atconcentrations in a range between about 25 mM and about 250 mM, e.g.,25, 50, 75, 100, 125, 150, 175, 200, 225, 250, 275, 300, 325, 350,375,400, 425, 450,475, 500, 525, 550, 575, or 600 mM. Another suitableacid is hydrochloric acid (HCl). HCl can be used at concentrations in arange between about 25 mM and about 200 mM, e.g., 25,40, 50, 60, 80,100,175, and 200 mM. “About” indicates that the acid concentration canvary by up to 10% above or below the recited value. Thus, for example,an acetic acid concentration of “about” 50 mM can include, for example,45 mM, 46 mM, 47 mM, 48 mM, 49 mM, 50 mM, 51 mM, 52 mM, 53 mM, 54 mM, or55 mM.

The ATM can be swollen in acid for any period of time required toproduce a homogeneous suspension of ATM fragments. The ATM can beswollen, for example, for about 0.5, 1.0, 1.5,2.0, 2.5, 3.0, 3.5,4.0,4.5, 5.0, 5.5, 6.0, 7.0, 8.0, 9.0, 10.0, 11.0, 12.0, 14, 16,18,20,22,24,26 or more hours. “About” indicates that the swelling time canvary by up to 0.2 hours above or below the recited value. Thus, aswelling time of “about” 3 hours can include, for example, 2.8 hours,2.85 hours, 2.90 hours, 2.95 hours, 3.0 hours, 3.05 hours, 3.10 hours,3.15 hours, or 3.20 hours.

The final concentration of ATM in the acid solution can be anyconcentration that swells uniformly and that results in a homogeneoussuspension of ATM fragments. The swelling properties may vary accordingto the source of the tissue from which the ATM was derived; in general,useful concentrations (w/v) for porcine-derived ATM can range from about0.1% e.g., 0.08%, 0.085%, 0.09%, 0.1%, 0.15% to about 4%, e.g., about3.8%, 3.85%, 3.9%, 4.0%, 4.05%, 4.1%, 4.15%, or 4.2%. A suitableconcentration for porcine-derived ATM is 0.5%. The extent of increase involume of the ATM fragments can be measured by collecting the ATMfragments by centrifugation and determining the volume occupied by thepellets before and after the swelling period (see Example 1). The changein volume can be fold, 1.5-fold, 2-fold, 3-fold, 4-fold, 5-fold, 6-fold,7-fold or more relative to the ATM prior to acid swelling. The extent ofthe swelling will vary from ATM to ATM and from species to species.Generally, but not necessarily, conditions for swelling are used thatresult in maximal swelling of the ATM. After swelling, the ATM fragmentswill occupy a volume at least 1.2 times greater than they occupied priorto swelling. For example, the fragments can occupy a volume that is 1.2times, 1.5 times, 1.8 times, 2.0 times, 3.0 times, 4.0 times, 5.0 times,6.0 time, 7.0 times, 8.0 times, 9.0 times, 10.0 times, 11.0 times, 12.0times or greater than the volume occupied prior to swelling. Any methodin the art can be used to assay the extent of the swelling, including,for example, without limitation, direct measurement of the volumeoccupied by the ATM, or indirect measurements such as changes indensity, viscosity or light scattering of the ATM solution.

The homogeneous suspension of the ATM fragments of the invention can besubjected to mildly elevated temperatures relative to ambienttemperature. As defined herein, ambient temperature is from about 23° C.to about 27° C., e.g., 23° C., 24° C., 25° C., 26° C. or 27° C. Asdefined herein, “mildly elevated temperatures” include temperaturesranging from about 28° C. to about 44° C., e.g., 28° C., 29° C., 30° C.,31° C., 32° C., 33° C., 34° C., 35° C., 36° C., 37° C., 38° C., 39° C.,40° C., 41° C., 42° C., 43° C. or 44° C. The ATM can be subjected tomildly elevated temperatures either before the acid swelling step, atthe same time as the acid swelling step, or after the acid swellingstep. “About” indicates that the temperature can vary by up to 2 ° C.above or below the recited value. Thus, a temperature of “about” 30° C.can include, for example, 28.0° C., 28.5° C., 29.0° C., 2.95° C., 30.0°C., 30.5° C., 31.0° C., 31.5° C., or 32.0° C. The homogeneous suspensionof the ATM fragments can be subjected to mildly elevated temperaturefor, for example, about 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5,4.0,4.5, 5.0,5.5, 6.0, 7.0, 9.0, 10.0, 11.0, 12.0, 14, 16, 18, 20,22, 24, 26 or morehours. “About” indicates that the swelling time can vary by up to 0.2hours above or below the recited value. Thus, a swelling time of “about”3 hours can include, for example, 2.8 hours, 2.85 hours, 2.90 hours,2.95 hours, 3.0 hours, 3.05 hours, 3.10 hours, 3.15 hours, or 3.20hours.

Once the ATM has been swollen in acid and subjected to elevatedtemperatures, it can be used to form either a biocompatible meshcomposition or a biocompatible dermal film composition. To form thebiocompatible mesh composition, the homogeneous ATM solution can beapplied to a biocompatible mesh such that the woven mesh is impregnatedwith the solution. Any methods for coating mesh materials that retainthe biocompatible properties of the coated mesh can be used. Forexample, swollen ATM can be poured or extruded into a container and themesh materials added to and/or embedded in the ATM suspension.Alternatively or in addition, the swollen ATM can be deposited onto themesh by aerosolization, spraying, centrifugation or filtration. Anycontainer know to those in the art can be used, for example, a flatpolypropylene or polystyrene dish. Alternatively, or in addition, themesh materials can be placed in an appropriately sized container or moldand coated by pouring or extruding the swollen ATM onto the mesh. Thecoated mesh can then be dried and, optionally, the coating and dryingprocess repeated one, two, three or more times.

In general, the mesh can be immersed in the ATM solution to a depth ofabout 0,5 to about 1.0 cm depending, in part, upon the extent ofswelling of the ATM swells and the coating thickness desired. Morespecifically, the mesh can be coated with about 5 mg to about 10 mg dryweight of ATM per cm² of mesh. Thus, the mesh can be coated with 5.0,6.0, 6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, or 10.0 mg of ATM per cm2 ofmesh. Depending upon how many times the coating process is repeated, theATM coating on the mesh can be from about 0.1 to about 1.0 mm thick. Thethickness of the coating may vary depending upon the intendedapplication. Thus, thinner coatings may be more suitable for mesh thatwill be rolled up and inserted, for example, via a trochar, whilethicker coatings may be used for mesh that will be applied directly to atissue in need of repair. Biocompatible dermal films can be formed bydrying the homogeneous ATM solution in an appropriate vessel to give afilm-like or sponge-like sheet that can be removed from the vessel (seeExample 2). Any vessel known to those in the art can be used, forexample, a flat polypropylene or polystyrene dish. Alternatively, acontoured dish can be used to provide texture or functionality, forexample, ribbing, ridging or corrugation, to the surface of the ATMcoating. The ATM solution can be applied to a surface to a depth ofabout 0.5 to 1.0 mm More specifically, about 5 mg to about 10 mg of ATMcan be used per cm² of vessel surface area. Thus, the vessel can becoated with 5.0, 5.5,6.0, 6.5, 7.0, 7.5, 8.0, 8.5, 9.0,9.5, or 10.0 mgof ATM per cm².

The biocompatible tissue repair composition can be dried by any methodknown in the art that will result in the retention of biological andphysical functions of the tissue repair composition. Drying methodsinclude, without limitation, e.g., air drying, drying in atmosphere of,or under a stream of, inert gas (e.g., nitrogen or argon). The dryingtemperature may be ambient temperature, e.g., about 25° C. or it can bea temperature that is mildly elevated relative to ambient temperature,e.g., 28° C., 29° C., 30° C., 31° C., 32° C., 33° C., 34° C., 35° C.,36° C., 37° C., 38° C., 39° C., 40° C., 41° C., 42° C., 43° C. or 44° C.Alternatively, the biocompatible tissue repair composition can befreeze-dried. Freeze-drying is a routine technique used in the art (see,for example, U.S. Pat. Nos. 4,619,257; 4,676,070; 4,799,361; 4,865,871;4,964,280; 5,024,838; 5,044,165; 5,154,007; 6,194,136; 5,336,616;5,364,756; and 5,780,295, the disclosures of all of which areincorporated herein by reference in their entirety) and suitableequipment is available from commercial sources such as Labconco (KansasCity, Mich., USA). Freeze-drying involves the removal of water or othersolvent from a frozen product by a process called sublimation.Sublimation occurs when a frozen liquid (solid) goes directly to thegaseous state without passing through the liquid phase. Those skilled inthe art are well aware of the different freeze-drying methodologiesavailable in the art [see, e.g., “A Guide to Freeze-drying for theLaboratory”-an industry service publication by Labconco, (2004); andFranks (1994) Proc. Inst. Refrigeration. 91: 32-39], Freeze-drying maybe accomplished by any of a variety of methods, including, for example,the manifold, batch, or bulk methods.

In some embodiments, the molecules of the ATM (e.g., collagenmolecules), with or without mesh substrates, can be chemicallycross-linked (e.g. covalently linked) to themselves and/or, in the caseof ATM-coated mesh substrates, to the mesh substrate. Chemicalcross-linking agents can be homo-bifunctional (the same chemicalreaction takes place at each end of the linker) or hetero-bifunctional(different chemical reactions take place at the ends of the linker). Thechemistries available for such linking reactions include, but are notlimited to, reactivity with sulfhydryl, amino, carboxyl, diol, aldehyde,ketone, or other reactive groups using electrophilic or nucleophilicchemistries, as well as photochemical cross-linkers using alkyl oraromatic azido or carbonyl radicals. Examples of chemical cross-linkingagents include, without limitation, glutaraldehyde, carbodiimides,bisdiazobenzidine, and N-maleimidobenzoyl-N-hydroxysuccinimide ester.Chemical cross-linkers are widely available from commercial sources(e.g., Pierce Biotechnology (Rockford, Ill.); Invitrogen (Carlsbad,Calif.); Sigma-Aldrich (St. Louis, Mo.); and US Biological (Swampscott,Mass.)). Particularly suitable cross-linking reagents include1-ethyl-3-[3-dimethylaminopropyljcarbodiimide hydrochloride (EDAC) andN-hydroxysulfosuccinimide (NHS).

Generally, cross-linking can be carried out by hydrating the driedcoated mesh or dermal film directly in a solution of a cross-linkingreagent. Alternatively, cross-linking reagents that are active at acidicpH can be added to acid swollen ATM before the ATM is poured over themesh or applied directly to the substrate. The duration of thecross-linking reaction may vary according to the cross-linking agentthat is used, reagent concentration, the source of the ATM, the type ofmesh substrate, the reaction temperature and the tensile strengthdesired.

Optionally, the biocompatible tissue repair compositions can besubmitted to treatments to diminish the bioburden. This process isexpected to decrease the level of infectious microorganisms within thebiocompatible tissue repair compositions. As used herein, a process usedto inactivate or kill “substantially all” microorganisms (e.g.,bacteria, fungi (including yeasts), and/or viruses) in the biocompatibletissue repair compositions is a process that reduces the level ofmicroorganisms in the biocompatible tissue repair compositions by least10-fold (e.g., at least: 100-fold; 1,000-fold; 10⁴-fold; 10⁵-fold;10⁶-fold; 10⁷-fold; 10⁸-fold; 10⁹-fold; or even 10¹⁰-fold) compared tothe level in the biocompatible tissue repair compositions prior to theprocess. Any standard assay method may be used to determine if theprocess was successful. These assays can include techniques thatdirectly measure microbial growth, e.g., the culture of swab samples onartificial growth media, or molecular detection methods, such asquantitative PCR.

The biocompatible tissue repair compositions can be exposed to γ-, x-,e-beam, and/or ultra-violet (wavelength of 10 nm to 320 nm, e.g., 50 nmto 320 nm, 100 nm to 320 nm, 150 nm to 320 nm, 180 nm to 320 nm, or 200nm to 300 nm) radiation in order to decrease the level of, or eliminate,viable bacteria and/or fungi and/or infectious viruses. More importantthan the dose of radiation that the biocompatible tissue repaircompositions is exposed to is the dose absorbed by the biocompatibletissue repair compositions. While for thicker biocompatible tissuerepair compositions, the dose absorbed and the exposure dose willgenerally be close, in thinner biocompatible tissue repair compositionsthe dose of exposure may be higher than the dose absorbed. In addition,if a particular dose of radiation is administered at a low dose rateover a long period of time (e.g., two to 12 hours), more radiation isabsorbed than if it is administered at a high dose rate over a shortperiod of time (e.g., 2 seconds to 30 minutes). One of skill in the artwill know how to test for whether, for a particular biocompatible tissuerepair compositions, the dose absorbed is significantly less than thedose to which the biocompatible tissue repair compositions is exposedand how to account for such a discrepancy in selecting an exposure dose.Appropriate absorbed doses of γ-, x-, or e-beam irradiation can be 6kGy-45 kGy, e.g., 8 kGy-38 kGy, 10 kGy-36 kGy, 12 kGy-34 kGy. Thus, thedose of γ-, x-, and or e-beam irradiation can be, for example, 12, 14,15, 16, 17,18, 19, 20,21,22, 23,24,25,26,27,28, 29, 30, 31, 32, 33, or34 kGy.

The biocompatible tissue repair composition components, the fragmentedATM and the biocompatible mesh, mixed or separated, can be irradiated(at any of the above doses) at any stage of the biocompatible tissuerepair composition preparation. In addition, the irradiation of thebiocompatible tissue repair composition can be the second or even thirdexposure of the components of the biocompatible tissue repaircomposition to irradiation. Thus, for example, the fragmented ATM andthe biocompatible mesh can be irradiated separately, mixed to form thebiocompatible mesh composition and then the biocompatible meshcomposition can be irradiated.

Generally, the biocompatible tissue repair composition is rehydratedprior to grafting or implantation. Alternatively, the biocompatibletissue repair composition can be grafted or implanted without priorrehydration; in this case rehydration occurs in vivo. For rehydration,the biocompatible tissue repair composition can be incubated in anybiologically compatible solution, for example, normal saline,phosphate-buffered saline, Ringer's lactate or standard cell culturemedium. The biocompatible tissue repair composition is incubated in asolution for sufficient time for the biocompatible tissue repaircomposition to become fully hydrated or to regain substantially the sameamount of water as the mixture from which the biocompatible tissuerepair composition was made contains. Generally, the incubation time inthe rehydration solution will be from about fifteen seconds to about onehour, e.g., about five minutes to about 45 minutes, or about 10 minutesto about 30 minutes. “About” indicates that the incubation time can varyby up to 20% above or below the recited value. Thus, an incubation timeof “about” 30 minutes can include, for example, 24 minutes, 25 minutes,26 minutes, 27 minutes, 28 minutes, 29 minutes, 30 minutes, 31 minutes,32 minutes, 33 minutes, 34 minutes, 35 minutes, or 36 minutes. Therehydration solution can optionally be replaced with fresh solution asmany times as desired. The temperature of the incubations will generallybe ambient (e.g., room) temperature or can be at from about 15° C. toabout 40° C., e.g., at about 20° C. to about 35° C. “About” indicatesthat the temperature can vary by up to 2° C. above or below the recitedvalue. Thus, a temperature of “about” 30° C. can include, for example,28.0° C., 28.5° C., 29.0° C., 2.95° C., 30.0° C., 30.5° C., 31.0° C.,31.5° C., or 32.0° C. The vessel containing the biocompatible tissuerepair composition and rehydration solution can be agitated gentlyduring the incubation if so desired. Following rehydration, thebiocompatible tissue repair composition can be further shaped or trimmedinto a form suitable for implantation at a particular site.

III. Tissue and Organ Repair

The biocompatible tissue repair compositions described herein can beused to treat any of a wide range of disorders in which amelioration orrepair of tissue is needed. Tissue defects can arise from diversemedical conditions, including, for example, congenital malformations,traumatic injuries, infections, and oncologic resections. Thus, thebiocompatible tissue repair compositions can be used to repair defectsin any soft tissue, e.g., tissues that connect, support, or surroundother structures and organs of the body. The biocompatible tissue repaircompositions can also be used in support of bone repair, e.g., as aperiosteal graft to support bone or an articular graft to drivecartilage repair. Soft tissue can be any non-osseous tissue. Soft tissuecan also be epithelial tissue, which covers the outside of the body andlines the organs and cavities within the body. Examples of epithelialtissue include, but are not limited to, simple squamous epithelia,stratified squamous epithelia, cuboidal epithelia, or columnarepithelia.

Soft tissue can also be connective tissue, which functions to bind andsupport other tissues. One example of connective tissue is looseconnective tissue (also known as areolar connective tissue). Looseconnective tissue, which functions to bind epithelia to underlyingtissues and to hold organs in place, is the most widely distributedconnective tissue type in vertebrates. It can be found in the skinbeneath the dermis layer; in places that connect epithelium to othertissues; underneath the epithelial tissue of all the body systems thathave external openings; within the mucus membranes of the digestive,respiratory, reproductive, and urinary systems; and surrounding theblood vessels and nerves. Loose connective tissue is named for the loose“weave” of its constituent fibers which include collagenous fibers,elastic fibers (long, thread-like stretchable fibers composed of theprotein elastin) and reticular fibers (branched fibers consisting of oneor more types of very thin collagen fibers). Connective tissue can alsobe fibrous connective tissue, such as tendons, which attach muscles tobone, and ligaments, which joint bones together at the joints. Fibrousconnective tissue is composed primarily of tightly packed collagenousfibers, an arrangement that maximizes tensile strength. Soft tissue canalso be muscle tissue. Muscle tissue includes: skeletal muscle, which isresponsible for voluntary movements; smooth muscle, which is found inthe walls of the digestive tract, bladder arteries and other internalorgans; and cardiac muscle, which forms the contractile wall of theheart.

The biocompatible tissue repair compositions can be used to repair softtissues in many different organ systems that fulfill a range ofphysiological functions in the body. These organ systems can include,but are not limited to, the muscular system, the genitourinary system,the gastroenterological system, the integumentary system, thecirculatory system and the respiratory system. The compositions areparticularly useful for repairs to connective tissue, including thefascia, a specialized layer that surrounds muscles, bones and joints, ofthe chest and abdominal wall and for repair and reinforcement of tissueweaknesses in urological, gynecological and gastroenterological anatomy.

The biocompatible tissue repair compositions are highly suitable forhernia repair. A hernia is the protrusion of the contents of a bodycavity out of the body cavity in which the contents are normally found.These contents are often enclosed in the thin membrane that lines theinside of the body cavity; together the membrane and contents arereferred to as a “hernial sac”. Most commonly hernias develop in theabdomen, when a weakness in the abdominal wall expands into a localizedhole or defect through which the intestinal protrusion occurs. Theseweaknesses in the abdominal wall typically occur in locations of naturalthinning of the abdominal wall, that is, at sites where there arenatural openings to allow the passage of canals for the blood vesselsthat extend from the abdomen to the extremities and other organs. Otherareas of potential weakness are sites of any previous abdominal surgery.Fatty tissue usually enters a hernia first, but it can be followed by asegment of intestine or other intraabdominal organ. If a segment ofinternal organ becomes trapped within the hernia sac such that the bloodsupply to the organ is impaired, the patient is at risk for seriouscomplications including intestinal blockage, gangrene, and death.Hernias do not heal spontaneously and often increase in size over time,so that surgical repair is necessary to correct the condition. Ingeneral, hernias are repaired by reinserting the hernia sac back intothe body cavity followed by repair of the weakened muscle tissue.

There are many kinds of hernias. With the exception of inguinal andscrotal hernias, which are only present in males, hernias can be foundin individuals of any age or gender. Examples of hernias include: directinguinal hernias, in which the intestine can bulge into the inguinalcanal via the back wall of the inguinal canal; indirect inguinalhernias, in which the intestine can bulge into the inguinal canal via aweakness at the apex of the inguinal canal; fermoral hernias, in whichthe abdominal contents pass into the weak area created by the passage ofthe femoral blood vessels into the lower extremities; scrotal hernias,in which the intestinal contents bulge into the scrotum; Spigelianhernia, in which the hernia occurs along the edge of the rectusabdominus muscle; obturator hernia, in which the abdominal contents(e.g., intestine or other abdominal organs) protrude into the obturatorcanal, lumbar hernias, e.g., Petit's hernia, in which the hernia isthrough Petit's triangle, the inferior lumbar triangle, and Grynfeltt'shernia, in which the hernia is through Grynfeltt-Lesshaft triangle, thesuperior lumbar triangle; Richter's hernia, in which only one sidewallof the bowel becomes strangulated; Hesselbach's hernia, in which thehernia is through Hesselbach's triangle; pantaloon hernia, in which thehernia sac protrudes on either side of the inferior epigastric vesselsto give a combined direct and indirect inguinal hernia; Cooper's hernia;epigastric hernia (in which the hernia occurs between the navel and thelower part of the rib cage in the midline of the abdomen); diaphragmaticor hiatal hernias, e.g., Bochdalek's hernia and Morgagni's hernia, inwhich a portion of the stomach protrudes through the diaphragmaticesophageal hiatus; and umbilical hernia, in which the protrusion isthrough the navel.

In contrast to hernias of congenital origin, incisional hernias, alsoknown as ventral or recurrent hernias, occur in the abdomen in the areaof an old surgical scar. Incisional hernias have a higher risk ofreturning after surgical repair than do congenital hernias. Moreover, inthe case of multiple recurrent hernias, i.e., hernias that recur aftertwo or more repairs have been carried out, the likelihood of successfulrepair decreases with each subsequent procedure.

The biocompatible tissue repair compositions can be used to treat othermedical conditions that result from tissue weakness. One condition forwhich the biocompatible tissue repair compositions are useful is in therepair of organ prolapse. Prolapse is a condition in which an organ, orpart of an organ, falls or slips out of place. Prolapse typicallyresults from tissue weakness that can stem from either congenitalfactors, trauma or disease. Pelvic organ prolapse can include prolapseof one or more organs within the pelvic girdle; tissue weakening due topregnancy, labor and childbirth is a common cause of the condition inwomen. Examples of organs involved in pelvic organ prolapse include thebladder (cyctocele), which can prolapse into the vagina; the urethra,which can prolapse into the vagina; the uterus, which can prolapse intothe vagina; the small intestine (enterocele), which can prolapse againstthe wall of the vagina; the rectum (rectocele), which can prolapseagainst the wall of the vagina; and vaginal prolapse, in which a portionof the vaginal canal can protrude from the opening of the vagina.Depending upon the organ involved and the severity of the prolapse,patients with pelvic organ prolapse may experience pain upon sexualintercourse, urinary frequency, urinary incontinence, urinary tractinfection, renal damage, and constipation. Remedies include bothnon-surgical and surgical options; in severe cases, reconstruction ofthe tissues of the pelvic floor, i.e., the muscle fibers and connectivetissue that span the area underneath the pelvis and provides support forthe pelvic organs, e.g., the bladder, lower intestines, and the uterus(in women) may be required.

The biocompatible tissue repair compositions are also useful in repairsof the gastrointestinal system. Esophageal conditions in need of repairinclude, but are not limited to, traumatic rupture of the esophagus,e.g., Boerhaave syndrome, Mallory-Weiss syndrome, trauma associated withiatrogenic esophageal perforation that may occur as a complication of anendoscopic procedure or insertion of a feeding tube or unrelatedsurgery; repair of congenital esophageal defects, e.g., esophagealatresia; and oncologic esophageal resection.

The biocompatible tissue repair compositions can be used to repairtissues that have never been repaired before or they can be used torepair tissues that have been treated one or more times withbiocompatible tissue repair compositions or with other methods known inthe art or they can be used along with other methods of tissue repairincluding suturing, tissue grafting, or synthetic tissue repairmaterials.

The biocompatible tissue repair compositions can be applied to anindividual in need of treatment using techniques known to those of skillin the art. The biocompatible tissue repair compositions can be: (a)wrapped around a tissue that is damaged or that contains a defect; (b)placed on the surface of a tissue that is damaged or has a defect; (c)rolled up and inserted into a cavity, gap, or space in the tissue. Oneor more (e.g., one, two, three, four, five, six, seven, eight, nine,ten, 12, 14, 16, 18, 20, 25, 30, or more) such biocompatible tissuerepair compositions, stacked or adjacent to each other, can be used atany particular site. The biocompatible tissue repair compositions can beheld in place by, for example, sutures, staples, tacks, or tissue gluesor sealants known in the art. Alternatively, if, for example, packedsufficiently tightly into a defect or cavity, they may need no securingdevice.

Therapeutic Agents

Therapeutic agents that aid tissue regeneration can be included in thebiocompatible tissue repair compositions. These agents can includecells, growth factors or small molecule therapeutics. These agents canbe incorporated into the biocompatible tissue repair compositions priorto the biocompatible tissue repair compositions being placed in thesubject. Alternatively, they can be injected into the biocompatibletissue repair composition already in place in a subject. These agentscan be administered singly or in combination. For example, abiocompatible tissue repair composition can be used to deliver cells,growth factors and small molecule therapeutics concurrently, or todeliver cells plus growth factors, or cells plus small moleculetherapeutics, or growth factors plus small molecule therapeutics.

Naturally, administration of the agents mentioned above can be single,or multiple (e.g., two, three, four, five, six, seven, eight, nine, 10,15, 20, 25, 30, 35, 40, 50, 60, 80, 90, 100, or as many as needed).Where multiple, the administrations can be at time intervals readilydeterminable by one skilled in art. Doses of the various substances andfactors will vary greatly according to the species, age, weight, size,and sex of the subject and are also readily determinable by a skilledartisan.

Histocompatible, viable cells can be restored to the biocompatibletissue repair compositions to produce a permanently accepted graft thatmay be remodeled by the host. Cells can be derived from the intendedrecipient or an allogeneic donor. Cell types with which thebiocompatible tissue repair compositions can be repopulated include, butare not limited to, embryonic stem cells (ESC), adult or embryonicmesenchymal stem cells (MSC), monocytes, hematopoetic stem cells,gingival epithelial cells, endothelial cells, fibroblasts, orperiodontal ligament stem cells, prochondroblasts, chondroblasts,chondrocytes, pro-osteoblasts, osteocytes, or osteoclasts. Anycombination of two or more of these cell types (e.g., two, three, four,five, six, seven, eight, nine, or ten) may be used to repopulate thebiocompatible tissue repair composition. Methods for isolating specificcell types are well-known in the art. Donor cells may be used directlyafter harvest or they can be cultured in vitro using standard tissueculture techniques. Donor cells can be infused or injected into thebiocompatible tissue repair composition in situ just prior to placing ofthe biocompatible tissue repair composition in a mammalian subject.Donor cells can also be cocultured with the biocompatible tissue repaircomposition using standard tissue culture methods known to those in theart.

Growth factors that can be incorporated into the biocompatible tissuerepair composition include any of a wide range of cell growth factors,angiogenic factors, differentiation factors, cytokines, hormones, andchemokines known in the art. Growth factors can be polypeptides thatinclude the entire amino acid sequence of a growth factor, a peptidethat corresponds to only a segment of the amino acid sequence of thenative growth factor, or a peptide that derived from the native sequencethat retains the bioactive properties of the native growth factor. Anycombination of two or more of the factors can be administered to asubject by any of the means recited below. Examples of relevant factorsinclude vascular endothelial cell growth factors (VEGF) (e.g., VEGF A,B, C, D, and E), platelet-derived growth factor (PDGF), insulin-likegrowth factor (IGF) I and IGF-II, interferons (IFN) (e.g., IFN-α, β, orγ), fibroblast growth factors (FGF) (e.g., FGF1-10), epidermal growthfactor, keratinocyte growth factor, transforming growth factors (TGF)(e.g., TGFα or β), tumor necrosis factor-α, an interleukin (IL) (e.g.,IL-1-IL-18), Osterix, Hedgehogs (e.g., sonic or desert), SOX9, bonemorphogenetic proteins (BMP's), in particular, BMP 2,4, 6, and 7 (BMP-7is also called OP-1), parathyroid hormone, calcitonin prostaglandins, orascorbic acid.

Factors that are proteins can also be delivered to a recipient subjectby administering to the subject: (a) expression vectors (e.g., plasmidsor viral vectors) containing nucleic acid sequences encoding any one ormore of the above factors that are proteins; or (b) cells that have beentransfected or transduced (stably or transiently) with such expressionvectors. Such transfected or transduced cells will preferably be derivedfrom, or histocompatible with, the recipient. However, it is possiblethat only short exposure to the factor is required and thushisto-incompatible cells can also be used.

Small molecule drugs can also be incorporated into the biocompatibletissue repair composition, thus facilitating localized drug delivery.Recurrent hernias can be refractory to repair, due, in some instances,to indolent bacterial colonization that weakens the repair site andretards healing. Long-term systemic administration of antibiotics mayonly be partially effective against such subclinical infections.Incorporation of antimicrobial agents into the biocompatible tissuerepair composition can provide local high concentrations of antibiotics,thus minimizing the risk of adverse effects associated with long termhigh systemic doses. An antimicrobial agent can be an antibiotic.Examples of antibiotics include, without limitation, any representativeclasses of antibiotics, e.g., 1) aminoglycosides, such as gentamycin,kanamycin, neomycin, streptomycin or tobramycin; 2) cephalosporins, suchas cefaclor, cefadroxil or cefotaxime; 3) macrolides, such asazithromycin, clarithromycin, or erythromycin; 4) penicillins, such asamoxicillin, carbenicillin or penicillin; 5) peptides, such asbacitracin, polymixin B or vancomycin; 6) quinolones, such asciprofloxacin, levofloxacin, or enoxacin; 7) sulfonamides, such assulfamethazole, sulfacetimide; or sulfamethoxazole; 8) tetracyclines,such as doxycycline, minocycline or tetracycline; 8) other antibioticswith diverse mechanisms of action such as rifampin, chloramphenicol, ornitrofuratoin. Other antimicrobial agents, e.g., antifungal agents andantiviral agents can also be included in the biocompatible tissue repaircompositions.

Chemotherapeutic agents can also be included in the biocompatible tissuerepair compositions. Malignant tumors that occur in soft tissue,including for example, tumors of the esophagus, stomach, colon, bladderare typically treated by tumor resection and systemic administration ofanticancer drugs. Incorporation of anticancer agents into thebiocompatible tissue repair compositions can provide local highconcentrations of chemotherapy, thus mitigating the toxicity associatedwith long term high systemic doses. Examples of classes ofchemotherapeutic agents include, without limitation, 1) alkylatingagents, e.g., cyclophosphamide; 2) anthracyclines, e.g., daunorubicin,doxorubicin; 3) cycloskeletal disruptors, e.g., paclitaxel; 4)topoisomerase inhibitors, e.g., etoposide; 5) nucleotide analogues,e.g., azacitidine, fluorouracil, gemcitabine; 6) peptides, e.g.,bleomycin; 7) platinum-based agents, e.g., carboplatin, cisplatin; 8)retinoids, e.g., all-trans retinoic acid; and 9) vinca alkaloids, e.g.,vinblastine or vincristine.

IV. Articles of Manufacture

The biocompatible tissue repair compositions provided herein can beincluded in an article of manufacture or as a kit. In one embodiment,the kit can include the biocompatible tissue repair composition,packaging material, or a package insert, comprising instructions for amethod of treatment. The packaging material can include components thatpromote the long term stability and sterility of the biocompatibletissue repair composition.

A number of embodiments of the invention have been described.Nevertheless, it will be understood that various modifications may bemade without departing from the spirit and scope of the invention.Accordingly, other embodiments are within the scope of the followingclaims.

EXAMPLES Example 1 Methods and Materials

Preparation of acellular tissue matrix (ATM). ATM was prepared fromporcine dermal tissue procured from Yucatan Mini-Pigs. Porcine dermaltissue was processed according to standard LifeCell protocols asfollows. Tissue was incubated in RPMI 1640 media containing 20 mM EDTAfor 24 hours at 4° C. Skin epidermis was removed by incubating thetissue sample with gentle agitation in a de-epidermizing solution(phosphate-buffered saline (PBS), 10 mM EDTA, 0.5% Triton X-100, withlincomycin, vancomycin, polymyxin B and cefoxitin) for 22.5 hours atroom temperature. The epidermal layer was then physically removed fromdermis. The epidermis was discarded and the dermis was subjected tofurther processing. Cellular components and debris were removed byrinsing the dermis in decellularizing solution (10 mM HEPES, pH 8.0, 10mM EDTA, 2% sodium deoxycholate) for 15 minutes, followed by gentleagitation in a fresh lot of decellularizing solution for 18 hours atroom temperature. The dermis was then incubated in DNAse solution (20 mMHEPES, pH 7.2, 20 mM calcium chloride, 20 mM magnesium chloride, and 1U/ml DNase (Pulmozyme®, Genentech, South San Francisco, Calif.),followed by washing in PBS, 10 mM EDTA, pH 7.2. The DNase-treated dermiswas then incubated in pre-freeze solution and freeze dried to producethe ATM in sheet form (XenoDerm™). The XenoDerm™ was micronized using aSpex-Certiprep Freeze Mill. The approximate particle size of themicronized XenoDerm™ was between about 100 and 200μ. The micronizedmaterial was used as the starting material for preparation of the coatedmesh and dermal films as described in the examples below.

Determination of cryoprotectant content of micronized porcine dermis.100 mg of micronized tissue was washed 3 times with water to removesoluble cryoprotectant. The washed material was then freeze-dried andweighed. It was determined that the micronized porcine dermis consistedof approximately 50% cryoprotectant and 50% acellular tissue matrix(ATM).

Swelling of ATM in acetic acid. A useful acetic acid concentration forswelling of regenerative tissue matrix (ATM) was empirically determined.50 mg of micronized porcine dermis, containing 26 mg ATM, was washed 3times with water, then suspended in 5 mL of acetic acid at theconcentrations indicated in Table 1. The ATM samples were incubated for3 hours at room temperature with occasional mixing. The swollen ATMparticles were allowed to settle, the volume occupied by the swollen ATMwas recorded; then the samples were subjected to low speedcentrifugation and the packed volume of the ATM pellets was recorded.100 mM acetic acid (pH at about 2.6) yielded almost maximal swelling ofthe ATM, i.e., the magnitude of the difference between swollen andpacked volume, as assessed either by gravity or centrifugation (Table1). At lower concentrations of acetic acid, the ATM swelling wasnon-uniform, producing a non-homogeneous suspension with largeparticulates. Attempts to increase the ATM concentration to greater than0.5% ATM (w/v) resulted in the formation of a non-homogenous suspensioncontaining numerous particulates that were not dissipated either byadding salt (10 mM sodium chloride) or increasing the pH (>3.0).

TABLE 1 Swelling of ATM in acetic acid Packed ATM Acetic acid (mM)Swollen ATM volume(ml) volume (ml) 0 0.4 0.4 25 3.0 2.2 50 3.6 2.6 1004.3 2.7 250 4.8 3.0

The integrity of the collagen fibers in the acid swollen ATM wasevaluated by transmission electron microscopy (TEM). Samples ofmicronized human dermis (Cymetra™) were rehydrated in 50, 100, 250 or500 mM acetic acid. Acid was removed by washing in 0.9% saline and thesamples prepared for transmission electron microscopy. Collagenperiodicity was observed in individual collagen fibers from all samplesanalyzed with no apparent differences in the banding pattern or fibersize. An increase in the separation of the collagen fibers that appearedproportional to the concentration of acetic acid used to rehydrate theCymetra™ was noted.

Example 2 Preparation and Comparison of Film-Coated and Sponge-CoatedPolypropylene Mesh

The initial steps in the preparation of the film-coated andsponge-coated mesh were identical. Briefly, the ATM was swollen in acidand poured over polypropylene mesh. Drying the coated mesh in anitrogen/air atmosphere produced a uniformly coated mesh, about 0.5 mmin thickness, that resembled cellophane; this material is referred to as“film-coated mesh”. In contrast, freeze-drying the coated mesh, resultedin material with a loose consistency, of about 2-3 mm in thickness,resembling a cotton-ball; this material is referred to as “sponge-coatedmesh”.

Preparation of film-coated polypropylene mesh. ATM (2.5 mg ATM/cm² ofpolypropylene mesh) was washed 3 times in water to remove residualcryoprotectant and salts, then swollen in 100 mM acetic acid at a finalconcentration of 0.5% ATM for 3 hours at room temperature. Polypropylenemesh (PROLENE mesh, Ethicon, Inc.) was cut into pieces of about 7.5cm×2.5 cm and each piece was placed individually in a single well (8cm×3 cm) of a 4-well polystyrene dish (Nunc, catalog# 267061). The acidswollen ATM was poured over the mesh to a depth of about 5 mm and thedish was incubated overnight in a nitrogen atmosphere. The driedfilm-coated mesh was lifted from the dish, hydrated for 15 minutes in100 mM acetic acid, inverted and transferred to a clean polystyrenecontainer. Freshly prepared acid swollen ATM was again poured over thefilm-coated mesh, which was then dried overnight in a nitrogenatmosphere. The dried double coated mesh was then removed from thepolystyrene container.

In some instances, the ATM film-coated mesh was submitted to across-linking procedure. The dried, coated mesh was incubated for 3hours at room temperature in 100 mM 4-morpholinoethanesulfonic acid(MES), pH 5.4, 20 mM 1-ethyl-3-[3-dimethylaminopropyljcarbodiimidehydrochloride (EDAC), 10 mM N-hydroxysulfosuccinimide (NHS) and 0.5:mlysine. Cross-linked mesh was rinsed in saline and kept hydrated priorto in vitro or in vivo analysis.

Preparation of sponge-coated polypropylene mesh. ATM (2.5 mg ATM/cm² ofpolypropylene mesh) was washed 3 times in water to remove residualcryoprotectant and salts, then swollen in 100 mM acetic acid at a finalconcentration of 5% ATM for 3 hours at room temperature. Polypropylenemesh (PROLENE mesh, Ethicon, Inc.) was cut into pieces of about 7.5cm×2.5 cm and each piece was placed individually in a single well (8cm×3 cm) of a 4-well polystyrene dish (Nunc, catalog #267061). Theacid-swollen ATM was poured over the mesh (2.5 mg ATM/cm² of mesh) to adepth of about 5 mm The acid-swollen ATM was poured over the mesh whichwas then freeze-dried. The dried sponge-coated polypropylene mesh wasthen removed from the polystyrene container.

In some instances, the ATM sponge-coated mesh was submitted to across-linking procedure. The dried, coated mesh was incubated for 3hours at room temperature in 100 mM 4-morpholinoethanesulfonic acid(MES), pH 5.4, 20 mM 1-ethyl-3-[3-dimethylaminopropyl]carbodiimidehydrochloride (EDAC), 10 mM N-hydroxysulfosuccinimide (NHS) and 0.5:Mlysine. Cross-linked mesh was rinsed in saline and kept hydrated priorto in vitro or in vivo analysis.

The acid swollen ATM formed uniform films and sponges when dried. Whenrehydrated with physiological buffers, the films and sponges remainedintact and maintained their original shape. Without acid treatment,dried micronized tissue failed to maintain shape when hydrated.Biomechanically, the films were stronger (both by touch and quantifiabletesting) relative to the sponges.

Tensile strength of films and sponges Films and sponges were preparedexactly as described in the methods above except that the polypropylenemesh was omitted from the samples. Films and sponges were rehydrated andtheir tensile strength was evaluated using an Instron 5865 testingmachine (Instron Corporation, Norwood, Mass.) according to themanufacturer's specification. The results of this experiment are shownin Table 2, below. The values represent the mean maximum stress of twoseparate samples. The cross-linked films had the greatest overallstrength and tolerated approximately 20-25% of the maximum stresstolerated by normal freeze dried ATM (Xenoderm™).

TABLE 2 Tensile strength of dermal films and sponges SampleCross-linking Maximum Stress (MPa) Film No 0.07 Sponge No 0.02 Film Yes4.05 Sponge Yes 0.09 normal sheet XenoDerm ™ No 15-20

Extracellular matrix denaturation temperature of films and sponges. Thepotential for the acid swollen ATM to remain stable under physiologicalconditions was also evaluated by in vitro methods, including, forexample, measuring the denaturation temperature of the extracellularmatrix, and the collagenase sensitivity of the acid swollen ATM. Thedenaturation temperature of the extracellular matrix was evaluated bydifferential scanning calorimetry (DSC). Hydrated samples were placedinto high volume DSC pans, sealed and run in a DSC Q100 (TA Instruments)using an equilibration temperature of 2° C. with a ramp of 2.5°C./minute to 95° C. Films and sponges were prepared exactly as describedin the methods above except that the polypropylene mesh was omitted fromthe samples. As indicated in Table 3, cross-linking appeared to increasethe temperature required to denature the collagen matrix. In contrast,the denaturation temperatures of the non-cross-linked films and spongeswere slightly less than that of the micronized porcine dermis from whichthey were made, indicating that the overall structural organization ofcollagen in the films and sponges was similar to that of nativecollagen. Moreover, the denaturation temperature of the films andsponges was higher than the normal mammalian body temperature of 37° C.,indicating that the films and sponges would be stable at physiologicaltemperatures.

TABLE 3 Denaturation temperature of dermal films and spongesDenaturation Sample Cross-linking Temperature (° C.) Film No 57 SpongeNo 57 Film Yes 70 Sponge Yes 70 Micronized porcine dermis No 64

Histological analysis of film- and sponge-coated polypropylene mesh.Film and sponge-coated polypropylene mesh samples were prepared asdescribed above, then sectioned and stained with hemotoxylin and eosin(H&E). Dense eosinophilic material surrounded the polypropylene mesh inthe film-coated mesh samples; in contrast, a loose network ofeosinophilic material surrounded the polypropylene mesh in thesponge-coated mesh samples. Collagen bundles, typically found in thedermal matrix, were not observed in either the film or sponge-coatedpolypropylene mesh samples, although there were histologic artifactsassociated with paraffin embedding of the mesh, suggesting the need forembedding in plastic prior to sectioning.

Example 3 Biocompatibility of Film- and Sponge-Coated Polypropylene Mesh

Biocompatibility of film- and sponge-coated mesh was evaluated in vivoin a time course experiment using an immune competent rat model. Film-and sponge-coated mesh samples, prepared with and without crosslinking,as described in Example 2, were implanted subdermally and removed foranalysis at 1, 3, and 5 weeks after implantation. Control samplesincluded uncoated polypropylene mesh and sheet Xenoderm™. Threereplicates of each test article were implanted for each time point.Implants were inserted into small subdermal pockets (4 per rat) createdon the dorsal surface of the animals. Following insertion of the testarticles, wounds were closed with surgical staples.

Qualitative histological analysis of the explants was performed toevaluate cellular repopulation, vascularization, inflammation andpersistence of the implanted extracellular matrix. Cellular repopulationand vascularization were assessed by evaluation of hematoxylin and eosinhistological sections; inflammation was evidenced by the presence ofcells with round densely stained nuclei; persistence of theextracellular matrix was evidenced by a uniform pinkish eosinophilicstaining characteristic of cell cytoplasm and extracellular matrixproteins.

Histological analyses indicated that the control uncoated polypropylenemesh samples showed a dense, inflammatory fibrotic response at 1 weekpost-implantation that diminished only slightly after 3 and 5 weeks postimplantation. The positive control, sheet XenoDerm™, which as describedabove, lacks a polypropylene mesh component, showed a relatively minorinflammatory response at the site of implantation, with an increasedrepopulation over the course of the 5 week time period. Both thesponge-coated polypropylene mesh and the cross-linked sponge-coatedpolypropylene mesh were fragile and tended to fall apart during theimplantation procedure. Inflammatory responses, similar to that observedfor the uncoated polypropylene mesh control samples, were noted for boththe non-cross-linked and the cross-linked sponge samples, although smallareas of extracellular matrix were still present in the latter at fiveweeks post-implantation. Mild inflammation was observed for both thefilm-coated polypropylene mesh and the cross-linked film-coatedpolypropylene mesh samples. However, persistence of extracellularmatrix, as well as cellular repopulation was noted for the film-coatedpolypropylene mesh samples over the 5 week time-course, while noevidence of cellular repopulation was observed for the film-coatedcross-linked polypropylene mesh samples. Thus, the film-coated meshpreparations showed the greatest degree of biocompatibility based onpersistence of the ATM, a relatively low level of inflammation, and thecapacity to repopulate and revascularize.

Example 4 Preparation of Polypropylene Mesh and Dermal Films Using aThermal Drying Method

The film-coated polypropylene mesh used in Examples 7, 10 and 11 and thedermal films used in Examples 5, 6, 7, 8, and 9 were made as follows.

Preparation of film-coated polypropylene mesh. Freeze-dried sheetXenoDerm™ was micronized according the method described above. ATM waswashed in water to remove residual cryoprotectant and salts, thenswollen in 100 mM acetic acid at a final concentration of 0.5% ATM for 3hours. The swelling temperatures ranged from 32-40° C. as detailed inthe specific examples below. The acid-swollen ATM was poured into apolystyrene dish and the polypropylene mesh (7.5 cm×2.5 cm pieces) wasimmersed in the ATM solution to a depth of about 1 cm; 0.75 mg acidswollen ATM was used per cm² of polypropylene mesh. The polypropylenemesh was coated only once. Samples were dried as indicated below inExamples 7, 10 and 11.

Preparation of dermal films. Dermal films, which did not containpolypropylene mesh, were prepared as follows. Freeze-dried sheetXenoDerm™ was micronized according the method described above. ATM waswashed in water to remove residual cryoprotectant and salts, thenswollen in 100 mM acetic acid at a final concentration of 0.5% ATM for 3hours. The swelling temperatures ranged from 32-40° C. as detailed inthe specific examples below. The acid-swollen ATM solution was pouredinto a polystyrene dish to a depth of about 0.5 cm; 0.75 mg acid swollenATM was used per cm² of the polystyrene dish. Samples were dried asindicated below in Examples 5, 6, 8, and 9.

Example 5 Extracellular Matrix Denaturation Temperature of Dermal Films

Dermal films were prepared as described in Example 4 above using ATMthat had been swollen at ambient temperature; films were dried in anitrogen environment at either room temperature or on a heating block at33° C., 37 ° C., or 43 ° C. Films that had been prepared using thecross-linking method described in Example 3, above, were included as apositive control. The denaturation profiles of the extracellular matrixof the resulting materials was evaluated by differential scanningcalorimetry (DSC). As indicated in Table 5, the denaturationtemperatures of the films dried at 33° C. and 37° C. were similar tothose of control films that had been dried at room temperature, whilethe denaturation temperature of films dried at 43° C. was reducedrelative to control films. Cross-linking appeared to increase thetemperature required to denature the collagen matrix. These datasuggested that because the denaturation temperature of the films washigher than the normal mammalian body temperature of 37° C., the filmswould be stable at physiological temperatures.

TABLE 5 Thermal denaturation of dermal films Drying Denaturationtemperature (° C.) Cross-linking Temperature (° C.) Room temperature No53 33 No 55 37 No 55 43 No 50 room temperature Yes 72

Example 6 Collagenase Sensitivity of Dermal Films

The potential for the ATM coating to persist under physiologicalconditions was also evaluated by measuring the collagenase sensitivityof dermal films. Optimally, the ATM coating should persist long enoughto permit cellular repopulation of the matrix, while still retainingenough of the native collagen structure to permit normal collagenturnover. Dermal films were prepared as described in Example 4 aboveusing ATM that had been swollen at ambient temperature dried in anitrogen environment at either room temperature or on a heating block at33° C., 37° C. and 43° C. Films that had been prepared using thecross-linking method described in Example 3, above, were included aspositive controls. Samples were digested with collagenase and thepercent of collagen remaining in each sample, relative to the undigestedsample, was assayed after 1,2, 4, 6, and 24 hours of collagenasetreatment. For collagenase digestion, 15-20 mg of dried film was placedin an eppendorf tube. Each sample was hydrated in 1 ml of 10 mM Tris, pH7.4, 5 mM CaCl₂, followed by the addition of 0.25 mg of collagenase (25(:1 of a 10 mg/ml solution) and incubated at 37° C. At the indicatedtime points, samples were cooled in ice and insoluble (non-digested)material was collected by centrifugation. Pellets were then dried andweighed to determine the percentage of remaining tissue. As indicated inTable 6, the cross-linked films were almost completely resistant tocollagenase degradation Films dried at elevated temperatures appeared tobe slightly more susceptible to collagenase than those dried at roomtemperature. The apparent increase in material in some of the latertimepoints in some of the samples reflects variability in the residualmoisture content of the small sample sizes. These data indicated thatthe collagen in the dermal films was accessible to collagenase and wasnot irreversibly denatured, suggesting that the collagen fibrils withinthe ATM coated mesh would be subjected to normal physiological collagenturnover.

TABLE 6 Collagenase sensitivity of dermal films: percent collagenremaining over time. Sample Drying Temperature (° C.) Collagenase Roomdigestion time Room temperature, (Hours) temperature 33 37 43 crosslinked 1 64% 30% 45% 8% 90% 2 25% 12% 18% 5% 92% 4 15% 10% 15% 10%* 93%6 10%  20%*  18%* 20%* 92% 24  0%  2%  0% 15%* 80% Percentages refer topercentages of collagen remaining in sample after collagenase treatment.

Example 7 Biocompatibility of Coated Mesh: Evaluation in a SubdermalImmune Competent Rat Model

The effect of preparation temperature on the biocompatibility of coatedmesh samples was evaluated in a subdermal immune competent rat model. Inbrief, the swelling temperature of the ATM and the drying temperature ofthe coated mesh was systematically varied according the conditions inTable 7, below. The coated mesh samples were implanted, and the implantsremoved and evaluated histologically at intervals of 1, 3 and 5 weekspost-implantation.

The experimental groups were designated A through F and were subject tothe following conditions. Samples B-F were immersed in the relevantswollen ATM fragment suspension and then treated as follows. Samples Cand D were prepared from ATM that had been swollen in 0.1M acetic acidat room temperature. After coating, sample C was dried at 37° C. andsample D was dried at 40° C. Sample E was prepared from ATM that hadbeen swollen in 0.1M acetic acid at 37° C.; sample F was prepared fromATM that had been swollen in 0.1 M acetic acid at 40° C. Both samples Eand F were dried at room temperature. Sample B was prepared from ATMthat had been swollen in 0.1M acetic acid at room temperature, coated atroom temperature and then dried at room temperature. Sample A, a controlfor factors related to coating in general, was uncoated polypropylenemesh. All samples were dried in a nitrogen atmosphere.

TABLE 7 Biocompatibility Study Experimental Design Swelling DryingSample Polypropylenemesh temperature (° C.) temperature (° C.) AUncoated not applicable not applicable B Coated RT^(a) RT  C coatedRT^(a) 37° D coated RT^(a) 40° E coated 37° RT^(a) F coated 40° RT^(a)^(a)RT = room temperature

Explants were removed at 1, 3 and 5 weeks following implantation andanalyzed histologically for evidence of persistence, cellularrepopulation, vascularization, and inflammation using the same criteriaas described in Example 2. Histological analyses indicated that all thecoated materials remained intact during the entire 5 week implantationperiod. All the coated materials were repopulated and revascularized.The level of inflammatory response induced by the coated mesh samples(Samples B-F) appeared to be relatively reduced compared to that inducedby the uncoated mesh (Sample A). Only a mild to moderate inflammationwas noted with all the coated mesh samples. This experiment confirmedthat mild heat treatment of the ATM, which resulted in increasedbiomechanical strength of the coated mesh, did not affect the in vivoactivity of the resulting coated mesh samples.

Example 8 Biochemical Analysis of Dermal Films

The effect of preparation temperature on the biochemical composition ofdermal films was evaluated. In brief, dermal films were prepared, asdescribed in Example 5, with ATM that had been swollen in 0.1 M aceticacid at either room temperature, 32° C., 37° C., or 40° C.; the filmswere dried at room temperature. The biochemical composition of theresulting dermal films was compared with that of micronized ATM.

Collagen analysis. The collagen content of dermal films was evaluatedquantitatively, by hydroxyproline analysis, and qualitatively, bySDS-polyacrylamide gel electrophoresis. For hydroxyproline analysis,dermal films were sequentially treated with salt, 0.5 M acetic acid andpepsin digestion and the soluble fractions of each were analyzed forhydroxyproline content. The Hydroxyproline content of salt, acid andpepsin fractions was determined following hydrolysis in 6 N hydrochloricacid for 24 hours at 110° C. Hydrolyzed samples were diluted withdistilled water to a final concentration of 0.1 N HCl. Assay buffer(45.6 g/l sodium acetate trihydrate, 30 g/l tri-sodium citratedihydrate, 4.4 g/l citric acid, 308.4 ml/l isopropanol and 1.4%chloramine T) was then added along with additional isopropanol andEhrlich's reagent (2 g para-dimethylamine-benzaldehyde in 60% (v/v)perchloric acid, isopropanol; 3:13). Samples were heated at 60° C. for25 minutes, allowed to cool and the absorbance at 540 nm was determined.Hydroxyproline was quantifed by comparing the absorbance of the testsamples with that of a standard curve using known concentrations ofhydroxyproline. The hydroxyproline content of the extracted fractions isshown in Table 8. Hydroxyproline is expressed as a percentage of totalrecovered hydroxyproline.

TABLE 8 Hydroxyproline distribution (%) in Dermal Films SampleMicronized Acid swollen Acid swollen Acid swollen Acid swollen FractionATM ATM (RT) ATM (32° C.) ATM (37° C.) ATM (40° C.) Salt- 9 25 33 31 27extracted Acid- 14 4 4 2 2 extracted Pepsin- 77 71 63 67 71 digested

The data shown in Table 8 indicate that, based upon the relativehydroxyproline distribution, all the dermal film samples showed anincrease in the levels of salt extractable collagen and a decrease inthe levels of acid extractable collagen relative to those found in themicronized ATM. No significant shift was observed for pepsin-solublecollagen. These data indicated that the collagen distribution in themajor pepsin soluble fraction was not significantly altered during theprocess used to create the films. The acid treatment used to create thefilms seemed to shift the distribution of the collagen from the acidextractable to the salt extractable fraction.

The pepsin-solubilized collagen obtained from dermal film samples wasanalyzed by SDS-polyacrylamide gel electrophoresis (SDS-PAGE) . SDS-PAGEwas performed according to standard methods. Samples of purifiedcollagen type I, purified collagen type III, pepsin-solubilized collagenfrom the micronized ATM starting material, and pepsin-solubilizedcollagen from dermal films prepared with ATM that had been swollen in0.1 M acetic acid at either room temperature, 32° C., 37° C., or 40° C.were compared. No qualitative differences, such as, for example,differences due to collagen cross-linking or degradation, in collagenprofiles were noted between the micronized ATM and any of the dermalfilm samples. The micronized ATM and the dermal film samples werecomposed primarily of type I and type III collagens.

Proteoglycan (decorin) analysis. Proteoglycans were extracted frommicronized ATM starting material and from dermal films prepared with ATMthat had been swollen in 0.1 M acetic acid at either room temperature,32° C., or 37° C. Proteoglycans were resolved by SDS-PAGE andtransferred to a membrane for immunoblotting Immunoblotting wasperformed according to standard methods. The membrane was probed with adecorin-specific polyclonal antibody. Comparable levels of decorin weredetectable in all the samples; no evidence of degradation orcross-linking was noted.

Glycosaminoglycan analysis. Glycosaminoglycans were extracted frommicronized ATM starting material and from dermal films prepared with ATMthat had been swollen in 0.1 M acetic acid at either room temperature,32° C., 37° C., or 40° C. Glycosaminoglycans were resolved by celluloseacetate electrophoresis according to standard methods. Hyaluronic acidand chondroitin sulfate glycosaminoglycans were detectable in allsamples and no qualitative differences in glycosaminoglycan profileswere observed.

Example 9 Biomechanical Analysis of Dermal Films

The effect of preparation temperature on the biomechanical properties ofdermal films was evaluated. In brief, dermal films were prepared withATM that had been swollen in 0.1 M acetic acid at either roomtemperature, 32° C., 37° C., or 40° C., as described in Example 5, driedin a nitrogen atmosphere, and 1 cm strips of the dermal films weresubjected to tensile testing using an Instron 5865 testing machine(Instron Corporation, Norwood, Mass.). The data shown in Table 9indicate that films prepared with ATM that had been swollen at elevatedtemperatures had increased tensile strength relative to films that hadbeen prepared with ATM that had been swollen at room temperature. Theoptimum temperature for maximum gain in biomechanical properties wasapproximately 37° C. Thus, for example, the maximum stress for filmsprepared with mesh that had been swollen at room temperature was0.017+0.007 MPa; the corresponding value for films prepared with meshthat had been swollen at 37° C. was 0.123+0.009 MPa. The Young's modulusfor films prepared with mesh that had been swollen at room temperaturewas 9.25+0.096 MPa; the corresponding value for films prepared with meshthat had been swollen at 37° C. was 46.0+3.00 MPa. The maximal load forfilms prepared with mesh that had been swollen at room temperature was0.056+0.002 N; the corresponding value for films prepared with mesh thathad been swollen at 37° C. was 0.0.337+0.024 N. The percent strain forfilms prepared with mesh that had been swollen at room temperature was21.1+1.0%; the corresponding value for films prepared with mesh that hadbeen swollen at 37° C. was 49.3+3.5%.

TABLE 9 Biomechanical properties of Dermal Films Sample Acid swollenAcid swollen Acid swollen Acid swollen Parameter ATM (RT) ATM (32° C.)ATM (37° C.) ATM (40° C.) Maximum stress (MPa) 0.017 ± 0.007 0.094 +0.025 0.123 ± 0.009 0.082 ± 0.024 Young's modulus (MPa) 9.25 ± .09639.00 ± 9.00  46.0 ± 3.00 29.75 ± 8.88  Maximum Load (N) 0.056 + 0.0020.291 + 0.087 0.337 + 0.024 0.214 + 0.062 Percent strain 21.1 ± 1.0 46.6 ± 3.0  49.3 ± 3.5  48.5 ± 3.4 

Example 10 In Vivo Analysis of Coated Mesh in a Rat Hernia Model System

The biocompatibility of the coated mesh was also evaluated in aclinically relevant rat hernia model system. Full thickness excisionaldefects (about 1.5 cm×2.5 cm) were created in the fascia of the ventralabdominal wall of rats. The defects was repaired by placing a 3 cm×5 cmoval shaped test article (polypropylene or hybrid) mesh into an underlayposition and fixing the mesh at the wound edge by sutures. Film coatedmesh was prepared essentially according to the method described inExample 5. The ATM was swollen at 37° C. and poured into polystyrenedishes. The mesh was immersed in the ATM solution to a depth of 0.5 cm;0.75 mg ATM/cm2 of polypropylene mesh was used.. For these experiments,a large piece of mesh (about 11 cm×18 cm) was coated as described above,dried at ambient temperature and then and cut into small (3 cm×5 cm)ovals prior to implantation). Samples were not cross-linked.

Excisional defects (about 1.5 cm×2.5 cm) were created in the abdomens ofrats and repaired with either polypropylene mesh or hybrid hernia meshusing a tension free underlay technique. Defects were created byremoving an oval shape piece of fascial tissue using scissors. Mesh testarticles were inserted into the defect and tacked at the wound edgeusing 6 evenly spaced sutures. The study used 16 rats, with 8 ratsreceiving polypropylene implants and 8 rats receiving hybrid meshimplants. Five rats in each group were analyzed 4 weeks afterimplantation and the remaining 3 rats at 8 weeks after implantation. Foranalysis, explants were collected and subjected to both gross andhistological evaluation. Percent coverage of surface area was estimatedby an investigator who was blind as to the identity of each sample.Extensive omental adhesions were observed upon inspection of thepolypropylene explants (approximately 65% surface area involvement);omental adhesions generated by the coated mesh explants involved onlyabout 18% of the surface area. In addition, visceral (liver and gut)adhesions were noted in two of the animals repaired with polypropylenemesh and were absent from animals repaired with the hybrid mesh.Indicators of a regenerative response, including cell repopulation,revascularization, minimal inflammation and graft persistence, wereobserved upon histological analysis of the hybrid mesh samples at 4weeks post-implantation. All coated test articles (with the exception oftwo samples that contained active infections) were characterized byrepopulation with fibroblast-like cells, revascularization, minimalinflammation and persistence of the biologic coating. In contrast, thepolypropylene test articles were associated with a greater cellularresponse around the polypropylene fibers consistent with an aggressiveforeign body response to the implanted mesh test articles.

Example 11 Preparation of Film-Coated Mesh Using ATM Procured fromYorkshire Pigs

ATM was prepared according to the method described in Example 1, exceptthat the dermal tissue was procured from Yorkshire pigs. The ATM wasmicronized and then washed in water to remove soluble cryoprotectant.The micronized ATM was swollen for 3 hours at 37° C. according to themethod in Example 1, except that the swelling took place in 40 mM HCl(pH 1.4) instead of 100 mM acetic acid. Polypropylene mesh was coated asdescribed in Example 2 and dried at room temperature.

The biocompatibility of the coated mesh was evaluated in a rat herniamodel system as described in Example 8. Indicators of a regenerativeresponse, including cell repopulation, revascularization, minimalinflammation, were observed upon histological analysis of the hybridmesh samples at 4 weeks post-implantation.

What is claimed is:
 1. A method of treatment, comprising: selecting abiocompatible mesh composition, comprising: a polypropylene sheetsubstrate; and a biocompatible coating surrounding the sheet substrate,wherein the coating comprises a dried group of particulate acellulartissue matrix (ATM) particles, wherein the ATM particles compriseacid-swollen intact ATM that retains biological functions provided byundenatured collagenous proteins and non-collagenous molecules;selecting an anatomical site; and implanting the mesh composition at theanatomical site.
 2. The method of claim 1, wherein the anatomical sitecomprises a hernia site.
 3. The method of claim 1, wherein theanatomical site comprises an abdominal wall defect.
 4. The method ofclaim 1, wherein the ATM comprises dermal ATM.
 5. The method of claim 1,wherein the ATM comprises ATM derived from at least one of fascia,pericardial tissue, dura, umbilical cord tissue, placental tissue,cardiac valve tissue, ligament tissue, tendon tissue, arterial tissue,venous tissue, neural connective tissue, urinary bladder tissue, uretertissue, and intestinal tissue.
 6. The method of claim 1, wherein the ATMis derived from human tissue.
 7. The method of claim 1, wherein the ATMis derived from non-human mammalian tissue.
 8. The method of claim 7,wherein the non-human mammalian tissue is porcine.
 9. The method ofclaim 7, wherein the tissue is from a non-human mammal that isgenetically engineered to lack expression of α-1,3-galactosyl epitopes.10. The method of claim 9, wherein the non-human mammal lacks afunctional α-1,3-galactosyltransferase gene.
 11. The method of claim 1,wherein the polypropylene sheet is a mesh.
 12. The method of claim 11,wherein the polypropylene sheet comprises polypropylene monofilament.